Pelvic peritonitis

Japanese: 骨盤腹膜炎 - こつばんふくまくえん（英語表記）Pelvic peritonitis
Pelvic peritonitis

What is the disease?

The pelvis contains the bladder in the front, the rectum in the back, and the uterus and fallopian tubes in between, all of which are covered by the peritoneum. Pelvic peritonitis is inflammation of the pelvic peritonium.

What is the cause?

Most cases of pelvic peritonitis develop when an infection progresses from the aforementioned cervicitis to endometritis, uterine adnexitis, and then pelvic peritonitis. Therefore, the causes of these cervicitis, endometritis, and uterine adnexitis can also be the cause of pelvic peritonitis.

Recently, the number of cases caused by sexually transmitted diseases such as chlamydia and gonorrhea has been increasing. In addition, it can develop if an intrauterine device (IUD) is left in place for a long period of time without being replaced. It can also develop from infection after abdominal surgery.

How symptoms manifest

In the acute phase, persistent pain and purulent vaginal discharge affect the entire lower abdomen. Chills ( Mom ) Symptoms include fever accompanied by shivering. nausea ( Oshin ) Vomiting may also occur.

As it progresses to the chronic stage, the organs in the pelvis adhesion ( Yuchaku ) Symptoms include lower abdominal pain, abdominal bloating, diarrhea, and constipation.

Testing and diagnosis

During the acute phase, tenderness in the lower abdomen is felt, and the abdominal wall muscles are tense and feel hard ( Muscle Guarding ( Healthcare worker ) Pelvic examination reveals tenderness in the uterus and adnexa. Blood tests reveal signs of acute inflammation, such as leukocytosis and positive CRP.

Due to peritonitis Exudate ( Exit station ) and pus accumulate in the pouch of Douglas (the peritoneal cavity between the uterus and the rectum), abscess ( Use ) The diagnosis of an abscess is Transvaginal ( Construction ) This is done using imaging tests such as ultrasound, CT, and MRI. A diagnosis is made based on medical history, symptoms, and examination and test findings.

Treatment methods

During the acute phase, antibiotic therapy is administered according to the causative bacteria.

Abscess or Pyosalpinx ( Dragon's Nun ) If antibiotic therapy is ineffective, surgical treatment may be necessary.

During the chronic phase, symptomatic treatment is given to treat symptoms such as pain and bowel movements.

What to do if you notice an illness

Appropriate antibiotic therapy is required and urgent medical attention is required.

Takeo Mizuguchi

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　骨盤内には前に膀胱、後ろに直腸、その間に子宮・卵管があり、それらの表面は腹膜でおおわれています。この骨盤腹膜に起こった炎症が、骨盤腹膜炎です。

原因は何か

　骨盤腹膜炎の多くは、前述の子宮頸管炎(けいかんえん)から子宮内膜炎(ないまくえん)、子宮付属器炎、そして骨盤腹膜炎へと感染が上行性に進むことにより発症します。したがって、これら子宮頸管炎、子宮内膜炎および子宮付属器炎の原因が、骨盤腹膜炎の原因になりえます。

　最近では、性行為感染症であるクラミジアと淋菌感染によるものが増えています。また、子宮内避妊器具（IUD）を交換せずに長期間装着していると、発症することがあります。そのほか、開腹手術後の感染から起こることもあります。

症状の現れ方

　急性期には、下腹部全体に及ぶ持続性の痛みや膿性帯下、悪寒(おかん)・震えを伴う発熱などが認められます。腹膜刺激による悪心(おしん)・嘔吐も認められます。

　慢性期に移行すると、骨盤内の臓器が癒着(ゆちゃく)を起こし、下腹部痛、腹部膨満感、下痢、便秘などがみられます。

検査と診断

　急性期には下腹部の圧痛が認められ、腹壁の筋肉が緊張し硬く触れます（筋性防御(きんせいぼうぎょ)）。内診では子宮や付属器に圧痛が認められます。血液検査では、白血球増多、CRP陽性などの急性炎症所見が認められます。

　腹膜炎による滲出液(しんしゅつえき)や膿汁がダグラス窩（子宮と直腸の間の腹膜腔）にたまり、膿瘍(のうよう)を形成することがあります。膿瘍の診断は、経腟(けいちつ)超音波断層法、CT、MRIなどの画像検査により行います。既往歴、症状および診察・検査所見から、診断を行います。

治療の方法

　急性期には原因菌に合った抗生剤療法を行います。

　膿瘍や卵管留膿腫(らんかんりゅうのうしゅ)を合併していて、これらが抗生剤療法で効果がない場合、外科的処置が必要になります。

　慢性期には、疼痛、排便などの症状に対症療法が行われます。

病気に気づいたらどうする

　適切な抗生剤療法が必要なので、早急に受診する必要があります。

水口　剛雄

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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