Atipik Klinik Prezantasyonlu Pelvik İnflamatuar Hastalık Olgusu

Abstract

…ZETPelvik inflamatuar hastalÝk (PID) olgularÝnÝn klinik a•Ýdan ge• tanÝnmasÝ mortalite ve morbidite a•ÝsÝndan šnemli sorunlar yaratmasÝ nedeni ile medikolegal a•Ýdan incelenmesini de gerekli kÝlmaktadÝr. Olgumuzu PID olgularÝnda sessiz klinik ile gidißin komplikasyonlarÝ Ÿzerinde durarak litaratŸr ile birlikte tartÝßmayÝ ama•lamaktayÝz. Olgumuz 38 yaßÝnda hastaneye uzun sŸredir devam eden nonspesifik kal•a ve bel aÛrÝlarÝ i•in baßvu-ran ve antienflamatuar tedavi gšrŸp en son yapÝlan aÛrÝ kesici ve anfienflamatuar enjeksiyondan sonra ani bir ßekilde šlen bir kadÝndÝr. DÝß muayenesinde saÛ ingunal dÝß yan ve saÛ uyluk Ÿst i• bšlŸmŸnde sarÝ yeßil renkte ekimoz alanlarÝ dÝßÝnda belirgin herhangi bir bulgu saptanmadÝ. Otopside akciÛerlerde konjesyon, batÝnda perihepatik ve perisplenik alanda gri yeßil renkte membranlar, karaciÛer ve dalak kapsŸllerinde fibršz kalÝnlaßmalar, saÛ over ve tubanÝn pelvis duvarÝna yapÝßÝk, Douglas boßluÛunda kolleksiyon olduÛu izlendi. Mikroskopik incelemede kalpte konjesyon, akciÛerlerde hiperemi, karaciÛerde baÛ dokusu artÝßÝ, parankim hŸcrelerinde yer yer nekroz, kšp-rŸleßme nekrozlarÝ, tuba uterina duvarÝnda ve omentumda yer yer folikŸl olußturan iltihabi hŸcre infiltrasyonu bulgularÝ gš-rŸldŸ. Laboratuar incelemelerinde ise herhangi bir šzellik saptanmadÝ. …lŸmŸn pelvik inflamatuar hastalÝÛa baÛlÝ gelißen hepatit, abse formasyonu ve peritonit sonucu meydana geldiÛi rapor edildi.Anahtar kelimeler: Pelvik inflamatuar hastalÝk, šlŸm, otopsi. SUMMARYPelvic inflamatory disease (PID) should be investigated on the aspect of clinically and medicolegally, since in clinical practice delayed diagnosis of these cases expose serious morbidity and mortality problems. In this study we aimed to underline complications and silent clinical course of PID case with literature review. Our case was 38 years old woman died in hospital where was treated for her nonspesific chronic hypocondriac and lumbar pain with antiflamatuary agents. Family history showed that victim had multiple sexual partners. On external examination there was yellow green colored bruise on right outer lateral and left inner aspects of inguinal region. On macroscopic examination lung congestion grayish green membranes in perisplenic and perihepatic areas, fibrous thickening of hepatic and splenic capsules, tuboovarian abses formation, yellowish fluid collection in Douglas pouch and tuba. On microscopic evaluation cardiac congestion, lung hyperemia, liver fibrosis, paranchymal cell, bridging necroses, lymphositic infiltration with follicle formation on tuba uterina wall and omentum. In toxicologic study no substance was detected. Finally death was declared as hepatitis, pelvic abses formation and peritonitis due to pelvic inflamatory disease.