RESUMO
Neisseria gonorrhoeae is the second most common etiological agent of pelvic inflammatory disease and is currently un-derdiagnosed due to its asymptomatic presentation in 50% of cases. When the disease presents, it may appear in the form of acute abdomen and normal imaging tests, making it a major diagnostic challenge. We present four cases of acute gonococcal peritonitis. The main symptom was acute abdominal pain, and both the gy-necological examination and complementary tests showed normal results. The only notable finding from the laparoscopy was the existence of purulent ascitic fluid. The results of the anatomical and pathological tests were all normal. Endocer-vical and ascitic fluid culture showed infection with N. gonorrhoeae, and in one case, concomitant infection with Chlamydia trachomatis. The definitive treatment applied was intravenous antibiotic therapy. When a sexually active young woman is diagnosed with peritonitis that has no apparent cause, it is important to rule out sexually transmitted diseases.
Assuntos
Gonorreia , Doença Inflamatória Pélvica , Infecções por Chlamydia , Chlamydia trachomatis , Feminino , Gonorreia/diagnóstico , Humanos , Neisseria gonorrhoeaeRESUMO
Resumen ANTECEDENTES: el estruma ovárico es un teratoma monodérmico, sumamente complejo, constituido en más de 50% por tejido tiroideo. Una forma infrecuente de manifestación es la estrumosis peritoneal, que consiste en múltiples implantes peritoneales benignos compuestos por estruma ovárico. No existe consenso en relación con el tratamiento; además, la malignidad de la estrumosis peritoneal es tema de controversia. CASO CLÍNICO: paciente nuligesta de 33 años de edad a quien, durante el estudio de esterilidad primaria, se le diagnosticó estruma ovárico derecho. A los tres años postratamiento recurrió en forma de estruma ovárico izquierdo y estrumosis peritoneal (hallazgo intraoperatorio). En ambos casos se efectuó quistectomía laparoscópica, y en la segunda ocasión se practicó, además, la exéresis de los implantes macroscópicos. Después de recibir quimioterapia con 131I (100 mCi) y entrar en remisión completa, se produjo una nueva recidiva cuatro años después; fue necesaria la cirugía citorreductora y un nuevo ciclo de quimioterapia con 131I (100 mCi). En la actualidad la paciente permanece en remisión completa. CONCLUSIONES: ante la escasez de casuística de estrumas ováricos y, sobre todo, de estrumosis peritoneal, resulta imprescindible individualizar el tratamiento en cada paciente, en donde es decisiva la participación de un equipo multidisciplinario. La cirugía citorreductora puede ser una opción terapéutica para favorecer la respuesta al tratamiento ablativo con 131I.
Abstract BACKGROUND: Struma ovarii is a highly specialized monodermic teratoma composed of thyroid tissue in more than 50%. An infrequent form of presentation is peritoneal strumosis, which consists of multiple peritoneal implants of benign mature thyroid tissue. In both situations, there is no consensus about the management of those entities. In addition, malignancy of peritoneal strumosis is controversial. CLINICAL CASE: We report a case of a 33-year-old nulligravid woman that during a sterility study was diagnosed with a right struma ovarii. Three years after treatment, it recurred as a left struma ovarii and a peritoneal strumosis (intraoperative finding). A laparoscopic ovarian cystectomy was performed in both cases, as well as the excision of all macroscopic implants in the second one. She remained in remission after 131I ablative chemotherapy (100 mCi), but a new recurrence took place four years later, requiring a cytoreductive surgery and a second 131I chemotherapy (100 mCi). She is now in complete remission. CONCLUSIONS: Due to the lack of casuistry of struma ovarii and paucity of information, especially in the case of peritoneal strumosis, decisions must be individualized on each patient and must be taken by a multidisciplinary team. Cytoreductive surgery might be an option to improve the response to ablative 131I chemotherapy.