[Clinical diagnosis of acute gonorrhic perihepatitis]

At the end of her menstruation a 25 years old woman develops acute pain in her right lower and upper abdomen radiating into the right shoulder. There are pains during breathing, coughing, and changing of position, vomitus, and local signs of peritonitis in the right lower and upper abdomen, subicterus and leucocytosis. Gonococci in the cervical smear are demonstrated by Grams stain and by culture. Two days after treatment with 3,5 millions IU of penicillin G sodium and 500.000 IU procaine penicillin per day the complaints disappeared. The demonstrated signs and symptoms are characteristic for acute perihepatitis gonorrhoica which seems to occur more often as a complication of gonococcal adnexitis than is suspected. The symptoms are so typical that the diagnosis can be made also without confirmation by laparascopy.