Case Report

A Rare Case of Small Bowel Obstruction in a Patient with Endosalpingiosis, Fitz-Hugh-Curtis Syndrome, and Chlamydia trachomatis Pelvic Inflammatory Disease

Table 1

History, findings, and management of small bowel obstruction in patients with PID.

AuthorsAgeHistoryManagement & findings

Baumgardner & McCanse [12]24(i) 3-week history of intermittent epigastric pain(i) Exploratory laparotomy and adhesiolysis
(ii) Fibrinous adhesion
(iii) PID treated with tetracycline
Harel and Lambrianides [10]19(i) Bile-stained emesis
(ii) CT abdomen showed a high-grade partial SBO
(i) Conservative management
(ii) Antibiotics
(iii) Nasogastric tube
(iv) Resolution of SBO within 2 days
Haumann et al. [4]27(i) Clinical obstructive symptoms
(ii) CT abdomen showed an acute SBO with no obvious aetiology
(i) Exploratory laparoscopy and adhesiolysis
(ii) The transition point was in the jejunum due to adhesion
(iii) Oral antibiotics for 3 weeks to treat Chlamydia trachomatis
Rossi et al. [13]54(i) Seven-day history of intermittent obstructive symptoms in a virgin abdomen
(ii) X-ray abdomen showed a dilated loop of small bowel anterior to the liver
(i) Exploratory laparotomy and adhesiolysis
(ii) Several adhesions between the liver and diaphragm with a loop of jejunum that had herniated between two of these adhesions
Rossi et al. [13]58(i) Three-day history of vomiting and crampy abdominal pain
(ii) X-ray abdomen showed evidence of complete SBO
(i) Exploratory laparotomy and adhesiolysis
(ii) A loop of midileum was entrapped between the adhesions above the right lobe of the liver causing complete obstruction
Pines et al. [14]35(i) Abdominal pain and recurrent bile-stained emesis
(ii) X-ray abdomen revealed slight dilated small bowel loops with air-fluid levels
(i) Exploratory laparoscopy then low-midline laparotomy
(ii) Left and right tubo-ovarian abscess adhered to small bowel identified
(iii) A left and right salpingectomy
Martin-Lagos Maldonado et al. [15]24(i) Two-day history of vomiting, hypogastric and right iliac fossa pain, fever, and vaginal discharge
(ii) Abdominal X-ray showed generalised dilation of small bowel. Pelvic and transvaginal ultrasound showed a heterogeneous cystic lesion on the right ovary and free fluid in the pouch of Douglas
(i) Exploratory laparoscopy then laparotomy. Right salpingectomy, adhesiolysis, and ileal resection
(ii) Formation of fibrotic adhesions towards the ileum intestinal wall. Salpingitis with a large right tubo-ovarian abscess
(iii) IV ertapenem then oral amoxicillin-clavulanic and metronidazole
Pegg and Owen [16]18(i) Recurrent abdominal pain and vomiting
(ii) Clinical and plain radiological signs of gastrointestinal obstruction
(i) Exploratory laparotomy, appendicectomy, adhesiolysis, and peritoneal lavage
(ii) Peritoneal cavity contained 900 ml of straw-coloured fluid, widespread adhesions between adjacent loops of small bowel
Harris and Lambrianides [11]18(i) Two-day history of colicky abdominal pain, bile-stained emesis, and constipation
(ii) CT abdomen showed dilated loops of small bowel and a small amount of free fluid within the pelvis
(i) Laparotomy and adhesiolysis
(ii) Multiple adhesions at terminal ileum
(iii) Free peritoneal fluid and bilateral pyosalpinx
(iv) Antibiotics
Ahmed et al. [9]38(i) One-day history of severe abdominal pain and three-week history of constipation
(ii) CT abdomen and MRI-pelvic showed dilatation of the colon with transition point in the sigmoid colon. Multiple bilateral cystic lesions suspicious for abscesses
(i) Conservative management
(ii) Intrauterine device removed
(iii) Doxycycline and ceftriaxone
Francesco et al. [17]49(i) One-day history of acute abdominal pain, febrile 38.5°C
(ii) Plain X-ray was normal
(iii) CT abdomen showed dilated loops of proximal small bowel with wall thickening and an air-fluid level
(i) Exploratory laparoscopy and peritoneal lavage
(ii) Nonmalodorous pus in the pelvis with signs of peritonitis. The uterus was oedematous, erythematosus, and swollen
(iii) Azithromycin and metronidazole
Al-Ghassab et al. [18]32(i) One-day history of obstructive symptoms
(ii) Abdominal X-ray showed subacute SBO
(iii) CT abdomen showed dilated loops of small bowel and left hydrosalpinx
(i) Exploratory laparoscopy and adhesiolysis
(ii) Multiple small bowel adhesions at the ileum and between the liver and anterior abdominal wall, free peritoneal fluid, and left hydrosalpinx
(iii) Antibiotics
Duffy et al. [19]23(i) 12-hour history of abdominal pain with a background history of PID
(ii) Normal erect and supine X-ray of the abdomen
(i) Diagnostic laparoscopy then laparotomy and adhesiolysis
(ii) Serous fluid in the pouch of Douglas, widespread adhesions on the capsule of the liver, jejunum, and proximal ileum and its mesentery with multiple hard lymph nodes and inflamed omentum