Chronic Pelvic Infection Research Articles

Cryptomenorrhea due to Agenesis of Upper Part of Vagina Treated by Vaginoplasty with Amnion Graft and Cervicovaginal Anastomosis: a Case Report

Cryptomenorrhea due to vaginal agenesis is a rare developmental anomaly of Mullerian duct. It may be complicated by retrograde menstruation, endometriosis and acute or chronic pelvic infection. We report a case of a 12-year-old girl who presented with a history of severe cyclical lower abdominal pain for 2 months. Her clinical examination revealed well developed secondary sexual characteristics, slightly bulged lower abdomen with a palpable tender mass and a short blind vagina. Ultrasound imaging showed hematometra, hematocervix and vaginal agenesis. She was treated by vaginoplasty with amnion graft and cervicovaginal anastomosis with serial vaginal dilatation using plastic vaginal mold. The patient was symptom free with regular menstruation on follow up visit at 1, 3 and 9 months. The Uterus was normal in size with empty cavity and well-defined endometrial lining on ultrasound. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):49-51

Management of Pariplutayonivyapad (Pelvic Inflammatory Disease): A Case Study

Pariplutayonivyapad is a disorder of the female genital tract due to vitiation of vata and pitta dosha. It is a disease of a reproductive age group. Symptoms of pariplutayonivyapad are much similar to pelvic inflammatory disease. Infection and inflammation of the upper genital tract, termed as pelvic inflammatory disease (PID), may be complicated by infertility, ectopic pregnancy, and chronic pelvic infection. Pelvic inflammatory disease is characterized by fever, dysparunia, abnormal vaginal discharge, burning, and painful micturition. PID can be effectively treated with ayurveda by using internal medicines and local therapy like yonipichu and matrabasti. Here we present a case of 38 year-old lady with chronic PID diagnosed as pariplutayonivyapad. The patient was treated with the basic principles of treatment along with local therapy. The patient got satisfactory result with ayurveda treatment without use of antimicrobial therapy.

Redo-surgery after failed colorectal or coloanal anastomosis: Morbidity, mortality and factors predictive of success. A retrospective study of 200 patients.

In cases of anastomotic failure after colorectal (CRA) or coloanal anastomosis (CAA), revision of the anastomosis is an ambitious surgical option that can be proposed in order to maintain bowel continuity. Our aim was to assess postoperative morbidity, risk of failure and risk factor for failure in patients after CRA or CAA. All consecutive patients who underwent redo-CRA/CAA in our institution between 2007-2018 were retrospectively included. The success of redo-CRA/CAA was defined by the restoration of bowel continuity 12months after the surgery. Two hundred patients (114male: 57%) were analyzed. The indication for redo-CRA/CAA was chronic pelvic infection in 74 patients (37%), recto-vaginal or urinary fistula in 59 patients (30%), anastomotic stenosis in 36 patients (18%) and redo anastomosis after previous anastomosis takedown in 31 patients (15%). Twenty-three percent of the patients developed a severe postoperative complication. Anastomotic leakage was diagnosed in 39 patients (20%). One-year-success of the redo-CRA/CAA was obtained in 80% of patients. In multivariate analysis, only obesity was associated with redo-CRA/CAA failure (p=0.042). We elaborated a pre-operative predictive score of success using the four variables: male sex, age>60years, obesity and history of pelvic radiotherapy. The success of redo-CRA/CAA was 92%, 86%, 80% and 62% for a preoperative predictive score value of 0, 1, 2 and ≥3, respectively (p=0.010). In case of failure of primary CRA/CAA, bowel continuity can be saved in 4 out of 5 patients by redo-CRA/CAA despite 23% suffering severe postoperative morbidity.

Indications, functional and quality of life outcomes of new pouch creation during re-do ileal pouch anal anastomosis: A comparative study with existing pouch salvage

BackgroundSalvage of the existing ileal pouch is favored during re-do ileal pouch anal anastomosis if the pouch is not damaged after pelvic dissection and there are no other mechanical reasons that may necessitate construction of a new pouch. Excision of the existing pouch may be associated with some concerns for short-bowel syndrome and poor functional outcomes. This study aimed to report indications and compare functional and quality of life outcomes of new pouch creation versus salvage of the existing pouch during re-do ileal pouch anal anastomosis. MethodsPatients who underwent re-do ileal pouch anal anastomosis between September 2016 and June 2020 were included. The reasons for pouch excision and new pouch creation were reported. Perioperative, functional outcomes and quality of life were compared between patients who had creation of a new pouch versus salvage of existing pouch. ResultsA total of 105 patients with re-do ileal pouch anal anastomosis (new pouch, n = 63) were included. Most common indications for a new pouch creation were chronic pelvic infection that compromised the integrity and viability of the existing pouch (n = 32) and small pouch (n = 21). No patient developed short-bowel syndrome. The number of bowel movements, daily restrictions and Cleveland Global Quality of Life score scores were similar between 2 groups. Day-time seepage, day-time and night-time pad usage were more common after new pouch creation. Two-year pouch survival rates were comparable (new pouch: 92% versus existing pouch: 85%, P = .31). ConclusionNew pouch creation can be safely performed at the time of re-do ileal pouch anal anastomosis. It provides acceptable functional and quality of life outcomes if existing pouch salvage is not feasible.

Isthmocele: A Review of Management Options for This Novel Entity

The incidence of cesarean section is on rise all over the world and so are the complications associated with the procedure. Isthmocele as a complication of cesarean section is becoming a well documented entity all over the world in medical literature. It presents with symptoms like prolonged post menstrual bleeding, chronic pelvic infection and infertility. A pregnancy can get lodged in this area and can have disastrous consequences for the patient. The present article is an attempt to review to various presenting complaints, diagnosis and management of Isthmocele.International Journal of Human and Health Sciences Vol. 03 No. 03 July’19. Page: 127-133

PTU-273 Postoperative symptomatic pelvic collections are more common after redo than after initial proctectomy for rectal cancer following neoadjuvant therapy

Introduction Proctectomy can be complicated by pelvic collection adversely affecting recovery; pelvic drains may reduce the incidence and/or severity of pelvic collections. Redo pelvic surgery is more complex due to chronic pelvic infection after anastomotic leak or cancer recurrence. The incidence of pelvic collection following redo proctectomy after neoadjuvant chemoradiation therapy (CRT) is unknown. This study evaluated the incidence of symptomatic pelvic collections in patients undergoing redo proctectomy compared to primary surgery after CRT. Method After IRB approval, data from patients with rectal cancer undergoing open redo proctectomy following neoadjuvant CRT between 2006–2013 were reviewed. The “redo” (Group A) was matched based on clinical characteristics and surgical strategies [Abdominoperineal resection (APR) vs low anterior resection with diverting loop ileostomy (LAR)] with patients undergoing primary proctectomy (Group B). All patients had pelvic drain at the time of surgery. Incidence of postoperative symptomatic pelvic collections was compared between groups. Clinical relevance of pelvic collection was evaluated by presence of leukocytosis, tachycardia, fever and positive fluid culture at diagnosis. Results 42 patients in Group A were matched with 42 patients in Group B based on age (58 ± 11 vs 60.9 ± 10 years), Body Mass Index (25.4 ± 5 vs 26.9 ± 4.7 kg/m2) ASA score, Charlson Comorbidity Index (2.8 ± 1.2 vs 2.7 ± 1) and surgical strategy (21 APR/21 LAR Group A vs 18 APR/24 LAR Group B). Postoperative symptomatic collections occurred in 10/42 (24%) patients in Group A vs 4/42 (9%) in Group B (p Conclusion Redo pelvic surgery following neoadjuvant CRT is associated with a significantly higher risk of pelvic collection development compared to de novoindex proctectomy, despite drain placement during surgery. Up to 40% of patients required a second percutaneous drain while the initial surgical drain was in place. Disclosure of interest None Declared.

Clinical Practice Examples of Dachaihu Decoction

This paper mainly describes the experiences of clinical application of Dachaihu Decoction in treating chronic pelvic infection, coronary heart disease, insomnia, and hepatolithiasis.

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Clinical observation on modified external therapy of traditional Chinese medicine to chronic pelvic inflammatory disease infections

Objective To evaluate the treating efficacy of application of improved external therapy of traditional Chinese medicine on chronic pelvic inflammatory disease infections.Methods Using case control study,we randomly classified patients with chronic pelvic inflammatory disease infections into two groups.The treatment group used Sihuangshui Honey on navel,enema with Maodongqing,and physical treatment on lumbosacral portion with pelvic instrument,while the control group took Jingangteng Capsule,Danshen injection,and application of Sihuangshui Honey on abdomen.Then we evaluated therapy results after two courses of treatment,and each course was 7 days.Treatment suspended during menstrual periods.Results The treatment group's significant efficiency was 64.79％,and total effective rate was 95.77％,while those of the control group were 38.03％ and 84.51％ respectively,Two groups showed significant difference( P＜0.05 ).The treatment group was superior to the control group as far as HEF Differential (P＜0.05) is concerned.Conclusion Improved exterrnal therapy of traditional Chinese medicine is effective and safe in treating chronic pelvic inflammatory disease infections.Extension of the treatmenf is worthwhile. Key words: Chronic pelvic inflammatory disease; Improved external therapy of traditional Chinese medicine

Serum resistin level is a predictor of ovarian response in in vitro fertilisation cycle

To measure serum resistin levels in infertile women undergoing in vitro fertilisation-embryo transfer (IVF-ET), and to find any correlations between serum resistin levels and body weight, body mass index, the number of oocytes retrieved, and the outcome of IVF-ET. In addition, to assess whether there is any difference in serum resistin levels between infertility caused by polycystic ovary syndrome (PCOS) and infertility caused by other female factors. We designed a case-control study, and a total of 44 infertile women were enrolled. The blood samples for resistin measurement were collected on day 3 of the menstrual cycle prior to the administration of gonadotropin during in vitro fertilisation. These cases were then divided into 2 subgroups (PCOS group versus non-PCOS group) and a number of variables were measured and compared, including serum resistin levels. Serum resistin levels were inversely correlated with the number of oocytes retrieved (r=-0.371, p=0.013). No significant correlation was found between serum resistin levels and body mass index or body weight, either in the whole group or in the 2 subgroups. Serum resistin levels in the non-PCOS group were significantly higher than in the PCOS group (p=0.049). Serum resistin levels in the non-PCOS group were inversely correlated to the number of oocytes retrieved (r=-0.386, p=0.039), but no similar correlation was found in the PCOS group. There was no correlation between serum resistin levels and fertility rate or clinical pregnancy rate in either subgroup. We observed a negative correlation between serum resistin levels and the number of oocytes retrieved during IVF. However, this phenomenon was only present in the non-PCOS group. This result suggests that serum resistin levels might be a good predictor of ovarian response in infertile women without PCOS during IVF. The role of serum resistin in response to inflammation caused by endometriosis or chronic pelvic infection, both of which are major causes of female infertility, should be examined in a further study.

Unilateral Twin Ectopic Pregnancy in a Patient With a History of Multiple Sexually Transmitted Infections

Background. The incidence of unilateral twin ectopic pregnancy is a rare condition. Several factors increase the risk of ectopic pregnancy, the most important of which is pelvic inflammatory disease, followed by operative trauma, congenital anomalies, tumors, and adhesions resulting in anatomically distorted fallopian tubes. We present a case of a woman with a history of four confirmed sexually transmitted infections (STIs) including Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex virus 2, and Treponema pallidum. The case illustrates the potential impact of sexually transmitted infections (STIs) on the risk of a twin ectopic pregnancy. Case. A 24-year-old primigravida, presented with an unknown last menstrual period, lower abdominal pain, watery vaginal discharge, and vaginal spotting. During this hospitalization, serum β-HCG testing was 263 mIU/mL and transvaginal ultrasonographic examination suggested a nonviable unilateral twin ectopic pregnancy. At exploratory laparotomy, a 10 cm mass involving the right fallopian tube and ovary was excised. Pathological evaluation of the specimen identified a monochorionic, diamnionic twin ectopic pregnancy within the fallopian tube. Conclusions Patients with a history of multiple (STIs) are known to be at risk for the development of chronic pelvic infection and postinflammatory scarring. The resulting distortion of the normal tubal anatomy leads to an increased risk of an uncommon presentation of ectopic pregnancy.

Fertility Profile Following Induced Abortion in Calabar, Nigeria

Context: The incidence of induced abortion in Nigeria is high. Pelvic infection as a complication of this abortion is also common and with the rising prevalence of infertility in the population, there is a need to assess the impact of induced abortions on fertility in our women. Objective: To establish the impact of induced abortion on the fertility rate of women in Calabar. Design and Setting: Cross sectional descriptive study in Calabar, an urban community on the eastern flank of Nigeria's Atlantic coast. Subjects and Methods: Women seeking gynaecological, antenatal and family planning services who gave their informed consent were recruited. Those of them who gave a history of induced abortion were interviewed in-depth. Their demographic characteristics and detailed information about their abortion history such as number of abortions, sites where the abortions were performed, the personnel providing the abortion services and complications arising from the abortions were obtained. Results: Some 242 (40.3%) of the study subjects had undergone at least one induced abortion. The commonest late complications of induced abortion were secondary infertility (42.1%) and chronic pelvic infection (36.0%). Only 48.3% of the women who had induced abortions maintained their fertility while the remainder suffered secondary infertility ranging from three to eighteen years in duration. The fertility rate decreased with increasing number of abortions. Conclusion: Induced abortion is a major factor in the high prevalence of secondary infertility in Calabar. Training of medical practitioners on post-abortion care may help to ameliorate the burden of secondary infertility in Nigeria. Key Words: Abortion, Pregnancy Termination, Fertility, Infertility [Trop J Obstet Gynaecol, 2003, 20: 89-92]

Risk factors for laparoscopically confirmed pelvic inflammatory disease: findings from Mumbai (Bombay), India.

OBJECTIVES: Sexually transmitted diseases (STDs) are an important cause of pelvic inflammatory disease (PID) but have often not been detected in microbiological studies of Indian women admitted to hospital gynaecology...

Genital tuberculosis in the woman--only of interest in medical history?

Genital tuberculosis still occurs and is difficult to diagnose. The symptoms are mostly uncharacteristic, whereas infertility and chronic pelvic infections are frequently diagnosed. In the period between 1970 to 1990, we found 21 women with this diagnosis. The occurrence seems to have shifted to greater age and milder clinical disease and are mostly observed within the framework of the sterility complex. We conclude, that primary treatment should be conservative. Intrauterine pregnancies after treatment are very rare, but, in one case, a normal pregnancy and delivery was occurred.

Complications of female circumcision in the Sudan.

This paper aims to identify and determine the prevalence of health problems encountered as a result of practising the Pharaonic, Intermediate and Sunna types of circumcision. A population of 3210 females from Northern Sudan were chosen by multistage random sampling. The study was carried out by means of a detailed questionnaire. Two types of complications were found: immediate and delayed. The immediate complications amounted to 790 (25%) from all the circumcised cases. The frequency for each type was: Pharaonic 26%, Intermediate 24%, Sunna 8%. The most common immediate complications were: difficulty in passing urine, wound infection and bleeding. The delayed complications amounted to 1023 (32%): Pharaonic 33%, Intermediate 31% and Sunna 15%. The most common delayed complications were the urinary tract infection, chronic pelvic infection, and results of tight circumcision. Circumcised respondents sometimes suffered more than one complication. The pattern of complications of Intermediate and Pharaonic circumcision was found to be the same.

Sterilization via the mini-laparotomy technique.

Mini-laparotomy is a proven method of postpartum tubal ligation using a small subumbilical incision for entrance to the peritoneal cavity. The 2 most popular sterilization procedures currently are the mini-laparotomy and laparoscopy. Laparoscopy requires expensive equipment and specialized medical training to use the equipment. Standard surgical instruments are used in mini-laparotomy. The severity of possible complications is great with laparoscopy; complications in mini-laparotomy e.g. hemorrhage or bladder injury can be easily repaired and often prevented by surgical technique. Patients should discontinue use of oral contraceptives 2-3 weeks before surgery. Contraindications against the operation are a retroflexed uterus endometriosis obesity previous laparotomy including cesarean section and chronic pelvic infection. Anesthetic may be general regional or local. With the right patient the local technique is suitable. The need for a uterine elevator and the type to be used is a controversial subject. Some doctors use the Ramathibodi elevator a Rubin cannula or a gauze pack. The procedure itself begins with a small transverse incision 3-4 centimeters long about 4 centimeters above the symphysis pubis. The rectus muscle is longitudinally split by blunt dissection and the peritoneum is identified. The peritoneum is grasped with hemostats and tented superiorly. Next the fallopian tube is elevated to the operative field.

Studies in pelvic iontophoresis: I. Iontophoresis in the treatment of pelvic infections with a report of 58 cases

1.1. Pelvic iontophoresis of a choline compound was given to 58 patients with subacute and chronic pelvic infection, all severe enough to warrant hospitalization; 37 were cases of tuboovarian infection and 21 were cases of cellulitis.2.2. Subjective improvement was generally marked, and often out of proportion to objective evidence of decrease of the infection.3.3. The results of therapy in tuboovarian infections, while often good, were not sufficiently remarkable to warrant routine use of this method of treatment. It seems clear that we cannot hope for resolution of old inflammatory tuboovarian masses, since fibrosis and multilocular cysts are a prominent part of the pathology. It may, however, be given a trial in persistent tuboovarian infections, when operative treatment is not indicated and other methods of treatment have been ineffective.4.4. The best response to iontophoresis was seen in cases of massive cellulitic infection of recent origin which had failed to yield to ordinary treatment. Pelvic iontophoresis is recommended for this type of infection.

Pelvic infections: An analysis of 550 operated cases with special reference to the sedimentation test in 100 gynecologic cases

Uncomplicated acute neisserian salpingitis should not be operated upon. Cases of acute puerperal infection are best treated symptomatically, unless drainage is indicated. Patients with acute exacerbation of a chronic pelvic infection should be operated upon after the temperature has remained normal for a few days and the leucocyte count and sedimentation time coincide. Pelvic abscesses should be drained vaginally, but not laparotomized until sufficient time has elapsed to show that the condition will not clear up. Chronic pelvic infections with symptoms and masses should be operated. Where the temperature and blood findings fail to reach normal after a sufficient time has elapsed, where the abdomen is flabby, the mass localized and the physical findings warrant, surgical interference is indicated.It is difficult to evaluate the sedimentation test in so small a group of cases, yet one will be impressed with the sensitiveness of the test. While I do not believe the test should supercede the blood count, it is a valuable adjunct. In cases of doubt as to operability, where there is a quick sedimentation time, one will act wisely to delay, or hurry if operation is inevitable. It is of value in making a differential diagnosis between advanced pregnancy and simple tumors, or between an unruptured tubal pregnancy and a tuboovarian infection. In eliminating infections anywhere in the body it should prove of assistance. One can at least determine positively the absence of infection if the sedimentation time is over one hundred and twenty minutes. While at times I have noticed a variance in the temperature, leucocyte count, and sedimentation time, yet upon further study the sedimentation time could usually be substantiated. The cases of advanced normal pregnancies were suggestive examples of the value of the test. In some cases a quick sedimentation time will assist in determining an emergency operation, e.g., suspected twisted pedicle of an ovarian cyst. It is a splendid check-up diagnostic and prognostic sign in doubtful cases. While sixty minutes is very comforting to the operator, I have not found it necessary to wait for a sedimentation time of sixty minutes to operate with safety. While there were no deaths in this series, it is undoubtedly safer to wait for the sedimentation time to be above thirty minutes. The sedimentation time is of material assistance in determining the time to operate and the prognosis in pelvic infections. Frequent tests should be made to obtain the best information.