Therapeutic Process of Gynecological Pelvic Abscess— Retrospective Review of 20 Cases

Aki Oride,Kohji Miyazaki,Haruhiko Kanasaki

doi:10.4236/ss.2013.43038

Abstract

Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.

Highlights

Pelvic inflammatory disease (PID) is caused by infection ascending from the vagina to the reproductive organs
Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients
Anaerobic bacteria were frequently detected as the causative bacteria

Summary

Introduction

Pelvic inflammatory disease (PID) is caused by infection ascending from the vagina to the reproductive organs. It may be a progression of endometritis, adnexitis or pelvic peritonitis. The clinical symptoms of pelvic abscess include fever and lower abdominal pain, and blood test findings of an increased white blood cell count (WBC) and increased C-reactive protein (CRP) level. It can be diagnosed with reasonable accuracy by a gynecological examination and imaging such as ultrasonography and magnetic resonance imaging. We reviewed patient background, treatment and clinical outcome of the cases of pelvic abscess we have experienced far, with the aim of evaluating the efficacy of our current treatment approach and determining any improvements that can be made

Patients and Methods

Results

Surgical procedure

Discussion

Conclusion