RESUMO
Pneumococcal peritonitis was diagnosed in a woman with an intrauterine device (IUD), admitted to the hospital with presenting symptoms of septic shock. The surgical, bacteriological and histological findings are described, and the preferred mode of treatment is discussed.
PIP: This article presents the case of a 39-year old gravida in whom pneumococcal peritonitis was diagnosed. She was admitted to the hospital with presenting symptoms of septic shock. A Lippes Loop IUD, inserted 2 years before admission, had been symptom-free. Laparotomy revealed purulent fluid throughout the abdominal cavity associated with a thick fibrinous exudate covering the adnexa and abdominal viscera. Streptococcus pneumoniae was cultured from peritoneal and pleural exudates. A total abdominal hysterectomy with bilateral salpingectomy and left oophorectomy was performed. Primary pneumococcal peritonitis is rarely encountered today, and early patient referral and antibiotics have decreased the poor prognosis of the disease. 5 cases in previously healthy adults have been described in the literature in the last 15 years, all of them in the presence of an IUD. However, the organism Str pneumoniae was isolated in only 1 of these cases. The present case illustrates the severe complications of primary pneumococcal peritonitis that can be encountered in females in the presence of an IUD. The device should be removed following acute infection. Explorative laparoscopy is indicated in cases where definitive cul-de-sac exudate is unobtainable. Peritoneal dialysis is recommended for patients who desire future pregnancy. This may be combined with bilateral salpingo-oophorectomy in cases where future fertility is not a consideration.
