| Pelvic abscess | |
| Field: | General surgery |
| Symptoms: | High fever, pelvic mass, vaginal bleeding or discharge, lower abdominal pain |
| Complications: | Sepsis, peritonitis, fistula |
| Causes: | Gynecological surgery, abdominal surgery, pelvic infection, appendicitis, inflammatory bowel disease |
| Diagnosis: | Blood tests, urine pregnancy test, blood and exudate culture, vaginal wet mount, medical imaging |
| Differential: | Ectopic pregnancy, PID, appendicitis, kidney stone, bowel obstruction, sepsis following miscarriage |
| Treatment: | Antibiotics, drainage, adequate hydration |
| Frequency: | Uncommon |
Pelvic abscess is a collection of pus in the pelvis, typically occurring following lower abdominal surgical procedures, or as a complication of pelvic inflammatory disease (PID), appendicitis, or lower genital tract infections.[1] Signs and symptoms include a high fever, pelvic mass, vaginal bleeding or discharge, and lower abdominal pain.[1] It can lead to sepsis and death.[1]
Blood tests typically show a raised white cell count.[1] Other tests generally include urine pregnancy test, blood and exudate culture, and vaginal wet mount.[1] Ultrasound, CT-scan or MRI may be used to locate the abscess and assess its dimensions.[1] Treatment is with antibiotics and drainage of the abscess; typically guided by ultrasound or CT. Endoscopic ultrasound (EUS) is a minimally invasive alternative method.
Signs and symptoms include a high fever, pelvic mass, vaginal bleeding or discharge, and lower abdominal pain.[1] There may be urinary frequency, diarrhoea, or persistent feeling of needing to pass stool.[2] Other symptoms may include fatigue, nausea, and vomiting.[3] Clinical features might not be apparent until the pelvic abscess has grown in size.[3] The lower abdomen is generally tender; one or both sides.[3] A bulging of the front wall of the rectum might be felt on digital examination via the rectum or vagina.[3]
Complications include sepsis and peritonitis.[1] In the longterm, a fistula may develop.[3]
Pelvic abscess typically occurs following gynecological surgery and abdominal surgery; hysterectomy, laparotomy, caesarian section, and induced abortion.[1] It may occur as a complication of pelvic inflammatory disease (PID), appendicitis, diverticulitis, inflammatory bowel disease (IBD), trauma, pelvic organ cancer, or lower genital tract infections.[1] [4] The abscess may be in the pouch of Douglas, fallopian tube, ovary, or parametrium.[1] It begins as inflammation or a collection of blood in the pelvis.[1] Other risk factors include immunodeficiency, pregnancy, hydrosalpinx, endometrioma, poorly controlled diabetes, kidney disease, obesity, and genital tract abnormalities.[1] [3] Opening the rectum to resect a rectal cancer may lead to developing a pelvic abscess.[4]
PID in females may lead to a tubo-ovarian abscess, where the abscess may be in the fallopian tube or ovary.[1] [3]
In children, it is more frequently associated with IBD and appendicitis.[5]
Blood tests typically show a raised white cell count, often with a high ESR and C-reactive protein.[1] Other tests generally include urine pregnancy test, blood and exudate culture, and vaginal wet mount.[1] Medical imaging to assess the dimensions and locate the abscess may include ultrasound, CT-scan or MRI.[1]
Other conditions that appear similar include ectopic pregnancy, PID, appendicitis, kidney stone, bowel obstruction, and sepsis following miscarriage or termination of pregnancy.[1]
Treatment is with antibiotics and drainage of the abscess; typically guided by ultrasound or CT, through the skin, via the rectum, or transvaginal routes.[4] Occasionally antibiotics may be used without surgery; if the abscess is at a very stage and small.[3] Until sensitivities are received, a broad spectrum antibiotic is generally required.[3] Sometimes, a laparotomy of laparoscopy is required.[3]
Endoscopic ultrasound (EUS) is a minimally invasive alternative method.[4] Treatment also includes adequate hydration.[1]
Further surgery such as is sometimes required to treat the underlying cause; such as salpingo-oophorectomy for tubo-ovarian abscess.[3]
Pelvic abscess responds well to antibiotics and hydration.[1] The outcome is less successful in the presence of fistula.[3]
It is uncommon.[3] The incidence of pelvic abscess is less than 1% in an individual undergoing obstetric and gynecological operative procedure.[4]