Gonococcal peritonitis following uterine manipulation at laparoscopy

Abstract

develop for the first time during normal pregnancy. Although the issue of whether pregnancy affords protection against peptic ulcers is not settled, some reports do indicate that increased estrogen, increased histaminase, and a decreased volume of gastric secretions during pregnancy may be protective. The ulcerogenic effects of steroidal therapy are well known. Severe stress, such as burns, pre-eclampsia, or surgical procedures, may cause stress ulcers of the gastrointestinal mucosa. Indeed, in Case 1. sepsis, in addition to preeclampsia. could possibly have played an important role. Gastric hemorrhage, although an uncommon condition complicating pregnancy, causes not only a diagnostic dilemma, but also a therapeutic one. During pregnancy, gastrointestinal examination without the use of radiography is preferable because of the teratogenie and carcinogenic potential of radiography. Insofar as treatment is concerned. it depends on a number of factors, such as the severity of hemorrhage, presence of perforation or penetration, and the stage of gestation. In the first case, surgical therapy (although radical) resulted in a good outcome. Medical therapy was effective in the second case, with the patient benefiting from the administration of cimetidine. Since the discovery of a more effective medical agent. this mode of therapy has become more appealing and ought to be tried whenever possible. In order to enhance fetal lung maturation in women giving birth prematurely. one may use glucocorticoids to reduce the risk of hyaline membrane disease: but caution is advised since the pre-eclamptic patient map be at increased risk of gastrointestinal hemorrhage if glucocorticoid therapy is used.