pelvic abscess
Introduction
Introduction to pelvic abscess Most of the pelvic abscesses are not treated promptly by acute pelvic connective tissue inflammation. The suppuration forms a pelvic abscess. This abscess can be confined to one or both sides of the uterus. The pus flows into the deep pelvic cavity and even reaches the rectal vaginal septum. Abscess caused by fallopian tube empyema, ovarian empyema, fallopian tube ovarian abscess is also a category of pelvic abscess. basic knowledge Sickness ratio: 0.5% Susceptible people: women are more likely Mode of infection: non-infectious Complications: septic shock abdominal abscess
Cause
Causes of pelvic abscess
Bacterial infection (25%):
The pathogens formed by pelvic abscess are mostly aerobic bacteria, anaerobic bacteria, gonococcus, chlamydia, mycoplasma, etc., but mainly anaerobic bacteria. The most commonly found in pus culture is Bacteroides fragilis, large intestine Escherichia.
Improper surgery (30%):
In recent years, it has been found that actinomycetes (especially Actinomyces genus) are common pathogens causing pelvic abscess and are related to the placement of intrauterine devices. This pathogen is difficult to culture, so it cannot be cultured by general methods. Pathogens do not mean that pathogens do not exist.
Disease change (25%):
Pelvic abscesses are often delayed or recurrent in the treatment of acute salpingitis and occur after the application of an intrauterine device.
Pathogenesis
Fallopian tube empyema is developed from acute salpingitis. When the umbrella and isthmus of the fallopian tube are closed due to inflammatory adhesions, the more pus in the lumen, the larger the sausage-like mass can be formed. The fallopian tube has acute inflammation, and the secretion can enter the ovary through the ovulation ovulation and gradually form an abscess. If the umbrella end is not closed when the fallopian tube is inflamed, the inflammatory in the lumen, the purulent secretion can flow into the pelvis and its organs. Surrounding, and accumulating in between, such as pus sinking in the uterine rectum, or a large amount of pus exudate from the pelvic peritoneum into the pelvic floor, can form a pelvic floor abscess, above which can be the fallopian tube, ovary, Intestinal curvature, acute pelvic connective tissue inflammation can also form a abscess if it is not treated in time, and pus can flow into the vaginal rectum to form a mass.
Prevention
Pelvic abscess prevention
Pelvic abscess is mainly caused by accumulation of pus after peritonitis or pelvic infection, which is a complication after peritonitis. Therefore, the key to preventing this disease is to actively treat peritonitis and enhance resistance. In addition, the majority of women should strengthen their exercise, enhance their physical fitness and improve their disease resistance. Take a bath, pay attention to keep the vulva clean, avoid sexual uncleanness or irregularity. If you have acute pelvic inflammatory disease, it should be treated promptly and effectively to prevent the development of pelvic abscess. Women who have suffered from pelvic abscess should be hospitalized promptly. Rest quietly during hospitalization, take a semi-recumbent position, and limit the abscess to the lower part of the abdominal cavity. Eat high-nutrient, digestible foods.
Complication
Pelvic abscess complications Complications , septic shock, abdominal abscess
Severe cases can be complicated by septic shock and painful shock.
Symptom
Symptoms of pelvic abscess Common symptoms High fever, abdominal pain, vaginal discharge, increased cervical pain, pelvic pain, abdominal tenderness, abnormal uterine bleeding, dysuria, abdominal pain, abscess
1. After the treatment of acute peritonitis, the symptoms are once again improved and the body temperature is increased again and the pulse is fast.
2. The lower abdomen bulges discomfort or dull pain, the frequency of stool increases, and the rectal irritation is caused by the mucus and the urgency.
3. There may be bladder irritation such as frequent urination, urgency, and dysuria.
4. There is tenderness in the lower abdomen, sphincter relaxation in the rectum, and the anterior wall of the rectum is full, tender and fluctuating.
Examine
Examination of pelvic abscess
Laboratory inspection:
1. White blood cells can be increased or normal.
2. ESR is accelerated by >40mm/h.
3. Serum C-reactive protein value increased >16mg / L.
Other auxiliary inspections:
1. B-type ultrasound: manifested as a circular or flaky anechoic area in the pelvic cavity, most of the boundaries are unclear, visible inside, spotted and strip-like medium echo or weak echo, can be detected after urination segment.
2. X-ray inspection:
(1) Standing abdominal plain film: pelvic abscess in addition to the general abdominal abscess, the liquid level in the abscess and reflex intestinal swelling, intestinal adhesion, and the fat or disappearance of the pelvic fat line, which is characterized by lateral observation of the humerus The anterior rectum is not inflated. If there is gas, the distance between the rectum and the tibia exceeds 15mm, or there is a sign of compression around it. The cecum or sigmoid colon has a contraction of the cecum and sigmoid colon. The signs of edema, the contrast agent passes quickly, and the local folds thicken. Can form a rectum, bladder or vaginal fistula.
(2) CT scan: pelvic abscess occurs mostly around the rectum, the lateral pelvic recess and the uterus rectum recessed, depending on the original lesion, the abscess can be biased in one place, the abscess wall thickens and rough, if there is liquefaction, the center is Low density, enhanced scanning is ring-enhanced, no enhancement in the central liquefaction zone, and gas in the abscess, which is a reliable basis for diagnosis.
3. Diagnostic puncture: Female married can be puncture from the posterior vaginal fornix, male can be rectal puncture, pus can be diagnosed.
4. Anal finger examination: It can be found that the anal canal sphincter is loose, and the soft rectum is full and tender.
Diagnosis
Diagnosis and diagnosis of pelvic abscess
diagnosis
According to the history, symptoms and the above examination, there is no difficulty in the diagnosis of large and low pelvic abscesses with fluctuations and tenderness. For example, after birth, after cesarean section, after abortion or other cervical surgery, the patient has high fever and lower abdomen. Pain, white blood cell count increased, blood sedimentation is fast, more can be diagnosed, pus puncture and pus extraction can be clearly diagnosed, pus should be used for general and anaerobic culture, to identify the type of pathogen for targeted antibiotic treatment.
In the higher position of the uterine inflammatory mass, it is difficult to determine whether the mass is an abscess by gynecological examination alone, and it is not safe to perform vaginal posterior iliac puncture. The above auxiliary diagnosis method must be used.
Differential diagnosis
The clinical manifestations of pelvic abscess are similar to acute endometritis and acute annexitis, acute pelvic connective tissue inflammation, etc., difficult to identify, should pay attention to the course of disease progression, acute pelvic inflammatory disease treated with appropriate and adequate antibiotics for 48 ~ 72h, no condition Better, combined with clinical manifestations and auxiliary examinations, it is not difficult to confirm the diagnosis.
