Objective: Chlamydia trachomatis is the most frequently encountered infectious disease in daily practice in gynecology. The infection exhibits a wide range of presentations, from asymptomatic infection to severe pelvic peritonitis, which is often difficult to differentiate from other forms of peritonitis. There have been reports of patients developing chlamydial peritonitis in the early postoperative stage after laparoscopic surgery. Here, we report 4 cases of chlamydial peritonitis that developed soon after laparoscopic surgery in asymptomatic patients.
Patients: Patient ages ranged from 26-50 years. The surgeries included 1 total laparoscopic ovarian cystectomy (TLC), 1 total laparoscopic hysterectomy (TLH), and 2 laparoscopic assisted myomectomies (LAM). There were no operative findings suggestive of adhesive chlamydial infection, but increased levels of chlamydial IgA were confirmed in all 4 patients. Repeat laparoscopic surgery was required in 1 patient who developed ulcerative colitis after LAM due to delayed resolution of inflammatory response. Operative findings included severe pelvic peritonitis with extensive abscess formation from the pelvic cavity to the muscular layer at the site of the myomectomy. The repeat surgical procedure included exfoliation of inflammatory adhesions, drainage of the abscess, removal of the suture in uterine muscle, and thorough irrigation of the abdominal cavity with normal saline solution.
Conclusions: We test all patients for Chlamydia antibodies as part of the pre-operative workup. Patients who test positive are treated with oral azithromycin hydrate before surgery.