Pelvic abscess

Introduction 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, and the pus flows into the deep pelvic cavity. The pelvic cavity is at the lowest part of the abdominal cavity, and the inflammatory exudate or pus in the abdominal cavity easily flows into it, forming a pelvic abscess. Because the pelvic peritoneal area is small, the absorption of toxins is also less, so the symptoms of systemic poisoning are mild and the local symptoms are relatively obvious. Its therapeutic effect is good and there are no serious prognostic symptoms.

Cause

(1) Causes of the disease:

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 and large intestine. Escherichia coli, in recent years, it has been found that actinomycetes (especially Actinomyces genus) are common pathogens causing pelvic abscesses, and are related to the placement of intrauterine devices. This pathogen is difficult to culture, so it is cultured by general methods. Failure to produce a pathogen does not mean that the pathogen does not exist. Pelvic abscesses are often delayed or recurrent in the treatment of acute salpingitis and occur after the application of an intrauterine device.

(2) 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. Ovarian ovulation, such as the fallopian tube has acute inflammation, and secretions can enter the ovary through the ovulation of the ovary and gradually form an abscess. In the case of inflammation of the fallopian tube, if the umbrella end is not closed, the inflammatory and purulent secretions in the lumen can flow into the pelvic cavity and its organs and accumulate between them. If the pus sinks in the uterine rectum, or the pus that is exuded from the severe pelvic peritoneum flows into the pelvic floor, it can form a pelvic floor abscess, which can be covered by the fallopian tube, ovary, and intestine. Acute pelvic connective tissue inflammation can also form a abscess if it is not treated in time, and the pus can flow into the vaginal rectum to form a mass.

an examination

Related inspection

Pelvic and vaginal B-hypertension routine urine routine

1. Acute attachment inflammation: After the formation of abscess, there is high fever, and the body temperature can reach about 39 °C. Heart rate and lower abdominal pain, acute abdominal pain accounted for 89%, chronic pain accounted for 19%, accompanied by increased vaginal discharge, abnormal uterine bleeding. The pelvic examination has obvious lower abdominal tenderness and cervical pain. The uterus and the double attachment area also have severe tenderness. Because of the tenderness, the double diagnosis is not satisfactory. Sometimes the uterus can be seen on the side of the uterus and the upper part of the uterus and the rectum. Some patients have a slow onset, the abscess formation process is slow, the symptoms are not obvious, and even there is no fever.

2. Abscess performance: Symptoms continue to deteriorate, relaxation type hyperthermia, peritoneal irritation sign is more obvious, rectal and bladder irritation symptoms such as rectal pressure, defecation and dysuria, and systemic poisoning symptoms. Double diagnosis and anal examination showed that the pelvic cavity was full, and the rectal uterus was thickened, hard or undulating, accompanied by obvious tenderness.

3. Abscess rupture performance: After a large amount of pus and blood, pyuria or a large amount of pus discharged through the vagina, the clinical signs such as high fever, abdominal pain, abdominal tenderness and other signs are obviously improved, and the original mass disappears or shrinks, indicating that the pelvic abscess has been directed to the rectum and bladder. The vagina is worn out.

4. Abscess broken into the abdominal cavity performance: sudden deterioration of the condition or lower abdominal pain continued to increase to full abdominal pain, accompanied by nausea, vomiting, chills, followed by a weak pulse, rapid drop in blood pressure, cold sweat dripping and so on. Abdominal breathing disappeared, diffuse tenderness in the whole abdomen, rebound tenderness, muscle tension, and abdominal distension, bowel sounds weakened or disappeared. It is suggested that the pelvic limited abscess will be broken into the abdominal cavity and must be treated urgently.

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. After the puncture and puncture, the pus can be diagnosed. The pus should be cultured as an ordinary and anaerobic bacteria 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 attachment inflammation, 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 sufficient antibiotics for 48 to 72 hours, the condition has not improved, combined with clinical manifestations and auxiliary examination, it is not difficult to confirm the diagnosis.

1. Acute attachment inflammation: After the formation of abscess, there is high fever, and the body temperature can reach about 39 °C. Heart rate and lower abdominal pain, acute abdominal pain accounted for 89%, chronic pain accounted for 19%, accompanied by increased vaginal discharge, abnormal uterine bleeding. The pelvic examination has obvious lower abdominal tenderness and cervical pain. The uterus and the double attachment area also have severe tenderness. Because of the tenderness, the double diagnosis is not satisfactory. Sometimes the uterus can be seen on the side of the uterus and the upper part of the uterus and the rectum. Some patients have a slow onset, the abscess formation process is slow, the symptoms are not obvious, and even there is no fever.

2. Abscess performance: Symptoms continue to deteriorate, relaxation type hyperthermia, peritoneal irritation sign is more obvious, rectal and bladder irritation symptoms such as rectal pressure, defecation and dysuria, and systemic poisoning symptoms. Double diagnosis and anal examination showed that the pelvic cavity was full, and the rectal uterus was thickened, hard or undulating, accompanied by obvious tenderness.

3. Abscess rupture performance: After a large amount of pus and blood, pyuria or a large amount of pus discharged through the vagina, the clinical signs such as high fever, abdominal pain, abdominal tenderness and other signs are obviously improved, and the original mass disappears or shrinks, indicating that the pelvic abscess has been directed to the rectum and bladder. The vagina is worn out.

4. Abscess broken into the abdominal cavity performance: sudden deterioration of the condition or lower abdominal pain continued to increase to full abdominal pain, accompanied by nausea, vomiting, chills, followed by a weak pulse, rapid drop in blood pressure, cold sweat dripping and so on. Abdominal breathing disappeared, diffuse tenderness in the whole abdomen, rebound tenderness, muscle tension, and abdominal distension, bowel sounds weakened or disappeared. It is suggested that the pelvic limited abscess will be broken into the abdominal cavity and must be treated urgently.

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. After the puncture and puncture, the pus can be diagnosed. The pus should be cultured as an ordinary and anaerobic bacteria 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.

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