Videolaparoscopy in diagnostics and treatment of patients with gynecological peritonitis

Objective: to assess the effectiveness of videolaparoscopic interventions in patients with gynecological peritonitis.

Material and methods: a comprehensive evaluation was conducted on all 44 patients diagnosed with gynaecological peritonitis. In most cases (13 patients, or 29.5%), the etiological factor was purulent salpingitis. Pyosalpinx was identified as the cause in 10 cases (22.7%), while rupture of a tubal abscess into the peritoneal cavity was observed in six patients (13.6%). A ruptured tubo-ovarian abscess was recorded in three cases (6.8%), and rupture of an ovarian abscess (piovarium) was identified as the cause in two patients (4.5%). Additionally, peritonitis was caused by rupture of an infected dermoid ovarian cyst in two cases (4.5%).

Results: all patients underwent surgical interventions of varying scope and nature depending on the cause of the peritonitis. In all cases, videolaparoscopy was initially performed for diagnostic purposes, yielding a sensitivity and specificity close to 100%. Radical source control via laparoscopy was achieved in 39 patients (88.6%). In five cases (11.4%), conversion to laparotomy was necessary due to extensive purulent-fibrinous peritonitis requiring small bowel intubation. Analysis of the postoperative course showed that six patients (13.6%) developed various complications, all of which were successfully managed conservatively without the need for reoperation. No fatalities were registered.

Conclusion: a comprehensive analysis confirms that laparoscopy is an effective diagnostic tool for identifying purulentinflammatory pathologies of the uterine adnexa. Based on these findings, laparoscopy is recommended for all cases of confirmed gynaecological peritonitis. This approach facilitates differential diagnosis from acute surgical abdominal conditions and enables effective source control in patients with gynaecological peritonitis.

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