Severe Pelvic Infection Research Articles

Severe Parametritis after Vaginal Delivery with Delayed Response to Broad Spectrum Antibiotics: A Case Report

Background: Postpartum infections, also known as puerperal fever, are bacterial infections of the female reproductive tract following childbirth or miscarriage. Symptoms usually include a fever greater than 38.0°C (100.4°F), chills, lower abdominal pain, and possibly bad-smelling vaginal discharge. It usually occurs after the first 24 hours and within the first ten days following delivery, but life-threatening infection may occur within hours of delivery. Cases Report: We reported a case of severe parametritis in the first 24 hours of delivery. Cesarean section is a risk factor for postpartum infections, and response to treatment is lower than vaginal delivery. Our case was a severe pelvic infection after vaginal delivery, and its risk factor was prolonged rupture of the membrane. Therefore, rapid diagnosis and treatment are necessary to prevent abscess formation and sepsis. Conclusion: In this case, rapid treatment with broad-spectrum antibiotics prevented abscess formation, sepsis, and hysterectomy.

Investigation of prevention and treatment of anastomotic bleeding after colorectal surgery

Anastomotic bleeding is a common complication after colorectal surgery, mainly manifesting as continuous or intermittent bloody stool. The risk factors for anastomotic bleeding mainly include suboptimal surgical skill, surgical methods (such as laparoscopic anastomosis), close distance between the tumor and the anal margin, benign colorectal diseases, anastomotic leakage after colorectal surgery, severe pelvic and abdominal infections, and the patient's own condition, etc. Anastomotic bleeding can be prevented by standardized operation and intraoperative endoscopic examination. Anastomotic bleeding is mostly a self-limited disease, which can be cured by conservative treatments such as fluid resuscitation, blood transfusion and endoscopic treatment. When serious anastomotic bleeding threatens the life of patients, surgical treatment should be taken into consideration decisively.

Severe Postoperative Bleeding After Stapled Hemorrhoidopexy: Incidence and Causes

Severe postoperative bleeding (SPB) represents a major issue of stapled hemorrhoidopexy (SH). The aim of the study is to assess SPB events over last 6 years. This essay is a retrospective study of clinical records on SH patients over a 6-year period 2012–2018 in the First Affiliated Hospital of a university. SPB events and other serious complications are assessed. A total of 41 of 3350 SH patients experienced SPB events and 49 SPB episodes (98%, 49/50) occurred within 14 postoperative days. Of the 41 SPB patients, 37 were discharged, 28 were identified as anastomotic bleeding, and 34 had an average Hb decrease of 33.9 g/l (range, 5–90 g/l). Univariate and multivariate analyses show the statistical significance between the SPB events and variables of surgeon group (p = 0.017 < 0.05), constipation (p = 0.030 < 0.05) and incarcerated hemorrhoid (p = 0.015 < 0.05). No postoperative mortality, rectal perforation, extrarectal/abdominal hemorrhage, and severe pelvic infection have been reported. SPB’s incidence is 1.25% and usually occurs within 2 weeks after SH. Patients with incarcerated hemorrhoid or constipation are more prone to SPB events, and extensive surgical experience can significantly reduce SPB events.

"Crown of Death"; Corona Mortis, a Common Vascular Variant in Pelvis: Identification at Routine 64-Slice CT-Angiography.

Objective:To establish the incidence of arterial corona mortis variant in angiographic studies being performed using a 64 slice CT scan machine in a series of patients.Methods:This was a prospective cross-sectional study including 100 consecutive patients undergoing routine clinically indicated, standard protocol, CT-angiography for the abdominal aorta and/or lower limbs using a 64 slice CT scanner. Patients having severe arterial insufficiency (Grade 4 stenosis on CT angiography), pelvic infections and tumours, patients with past pelvic trauma and those who had previous pelvic surgery were excluded from the study. In total 200 hemi-pelvises were evaluated for the presence or absence of corona morti.Results:Overall, we included 100 patients in this series including 67 men and 33 women with mean age of 40.1±2.3 (ranging from 22-74) years. The arterial variant was identified on thin, 0.625-mm-thick images in 24 out of 100 patients studied (unilateral in 20 patients and bilateral in 4 patients; 28 out of 200 hemipelvises evaluated, having an incidence of 14%). We found that the distance of corona mortis artery from the symphysis was significantly greater for women compared to men, both on right (p=0.034) and left sides (p=0.046). Conclusion:Corona mortis may be prospectively identified at contrast-enhanced multidetector CT especially in pelvic trauma patients and help guide subsequent endovascular embolization or surgical interventions.

A case of abdominal-pelvic infiltrative lesion of chronic active Epstein–Barr virus infection

Epstein–Barr virus (EBV) belongs to a subfamily of herpesviruses, also known as human herpesvirus type 4. EBV is widely distributed in the population, with a high infection rate of 90%. EBV infects mainly B lymphocytes, stimulates cell proliferation and transformation and even causes cancer. In recent years, it has been found that it can also infect T lymphocytes, epithelial cells and natural killer (NK) cells and can cause related diseases. EBV infection can cause a variety of clinical symptoms and clinical manifestations, which brings some confusion to clinical diagnosis and easily leads to missed diagnosis and misdiagnosis. In this article, we report a case of EBV-induced severe abdominal and pelvic infection, which eventually led to death.

Tubo-Ovarian Abscess Caused by Pasteurella multocida in a Young, Intrauterine Device–Wearing Woman Without Animal Contact

Abstract Tubo-ovarian abscesses are usually caused by anaerobic bacteria alone or in mixed infection. Here, we report about a successfully treated 29-year-old patient with bilateral tubo-ovarian abscess caused by Pasteurella multocida. She had no exposure to animals. After the removal of a 1-year-old copper-T intrauterine device at the time of hospitalization, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed by laparotomy because of the level of the inflammatory lesion of both ovaries. After the administration of antibiotic combination, the patient was discharged home on the fifth postoperative day. In the setting of a tubo-ovarian abscess, rare zoonotic pathogens, such as P. multocida, should also be considered as a causative agent of the infectious process even in the absence of direct or indirect contact with animals. It seems that the asymptomatic colonization of the vagina and the intrauterine device with P. multocida may happen also from unknown origin of the environment with the consequences of severe pelvic infection with tubo-ovarian abscess formation.

Actinomyces neuii infection following ovarian cystectomy

Background: Abdominal Actinomyces infections are rare complications of surgery. A case of Actinomyces neuii presenting as a severe postoperative pelvic infection is described.Case: A 30 year-old nulligravid female was transferred from an outside hospital for a postoperative fluid collection, fever, leukocytosis, and abdominal pain following exploratory laparotomy and bilateral ovarian cystectomy. She rapidly decompensated requiring emergent exploratory laparotomy, bilateral salpingooophorectomy, and abdominal washout. Cultures isolated A. neuii. Following a prolonged ICU admission, she was treated with prolonged antibiotics and made a complete recovery.Conclusions: Rare pathogens, such as A. neuii, may cause severe infections following gynecologic surgery. Multidisciplinary care at tertiary care facilities is critical.

Histerectomía obstétrica por sepsis en el puerperio

Bleeding of obstetric origin and severe pelvic infections are the main causes of hysterectomy in the puerperium. Timely diagnosis and hysterectomy influence the outcome of these patients.The main objective of the present study was to analyze obstetric hysterectomy for severe pelvic infectious processes. We retrospectively analyzed obstetric hysterectomies for severe pelvic infectious processes and sepsis in the puerperium performed over a 5-year period in the General Hospital of Mexico. Seventeen cases of obstetric hysterectomy were analyzed. Most patients were aged between 20 and 30 years. The main indication was endometritis in 35.2%, and the mean operating time was 124.4min. The main complications were urinary tract lesions and those secondary to the septic process (disseminated intravascular coagulation). Mortality was 35%.

Rotura vesical extraperitoneal coincidiendo con esquirlas óseas: necesidad de tratamiento quirúrgico

IntroductionIn closed traumatic bladder ruptures, a surgical treatment of the intraperitoneal rupture, and a conservative approach to the extraperitoneal one, with bladder catheter, antibiotics and confirmation of bladder wound closure after two to three weeks-, was recommended. Only recently, attention was paid to the importance of the presence of bone fragments of the pelvic fractures, that in the vecinity of a bladder catheter or urinary infection may give raise to either severe pelvic infection or permanent urinary fistula. Patients and MethodThe two cases of extraperitoneal bladder rupture here presented, demonstrate the difficulties of a secure diagnosis by CT, and the potential severity of the existence of bone fragments impronting the bladder disruption. CommentRecent consensus on genitourinary trauma emphasizes the need to pay attention to the presence of bone fragments of the pelvic ring fractures in cases of closed bladder rupture. In cases of extraperitoneal bladder rupture with bone fragments in the vecinity, bladder endoscopic examination and surgical treatment may be needed.

Extensive vulval oedema secondary to severe pelvic infection

A 17-year-old female developed a complex pelvic abscess a few weeks post-surgical abortion. Despite surgical drainage, a debilitating infection induced a low albumen. The resulting pelvic oedema caused gross vulval oedema that was difficult to manage. She had previously been treated for chlamydia.

Imipenem and cilastatin sodium

Imipenem/cilastatin sodium is a fixed combination of imipenem, a carbapenem antibiotic, and cilastatin sodium, a dehydropeptidase 1 inhibitor. It produces rapid bacterial-cell-wall lysis by attaching to penicillin-binding proteins on the bacterial cell wall and is bactericidal against a broad spectrum of pathogens. It is available for both intravenous and intramuscular administration. of particular relevance to obstetricians and gynecologists is that the drug reaches therapeutic levels in pelvic organs and abscess cavities. However, resistance has been noted in Clostridium difficile and Pseudomonas aeruginosa, and imipenem/cilastatin has no activity against Chlamydia trachomatis or genital mycoplasmas. Imipenem/cilastatin is well tolerated; the most common side effects are phlebitis at the site of injection, transient elevation in serum transaminases, and allergic reaction. Nonetheless, its high cost precludes its routine use as a first-line agent for the treatment of mild to moderately severe pelvic infections. Its main role lies in the treatment of nosocomial infections, especially in the immunocompromised host or the patient with renal dysfunction.

Salpingitis or oophoritis: What causes fever following oocyte aspiration and embryo transfer?

Febrile morbidity following in vitro fertilization and embryo transfer (IVF-ET) is a rare but possibly serious complication. This report describes a case of salpingitis after IVF-ET and discusses the possible reasons for febrile morbidity following this common procedure.A 37-year-old woman undergoing IVF-ET for tubal factor infertility developed sudden, severe pelvic pain, fever, and leukocytosis 24 hours after ET. Laparoscopy revealed bilateral suppurative pyosalpinges with cystic, hemorrhagic ovaries. Pain, fever, and leukocytosis resolved with conservative surgery and intravenous antibiotic therapy.This case presents laparoscopic documentation of a rare complication of oocyte aspiration and/or ET, namely, salpingitis. Possibilities for the development of salpingitis following IVF-ET include activation of quiescent bacteria within the fallopian tubes from a previous pelvic infection, puncture of the bowel during oocyte aspiration, inoculation of the pelvis with cervicovaginal flora during oocyte aspiration, and introduction of bacteria-laden secretions or air into the fallopian tubes during ET. Although rare, the possibility of severe pelvic infection following IVF-ET warrants consideration of prophylactic antibiotic coverage.

Fine-needle aspiration cytology in the management of gynecologic oncology patients.

Fine-needle aspiration cytology has received little attention by physicians involved in the care of gynecologic oncology patients. Concerns over diagnostic accuracy and complications such as rupture of cystic ovarian tumors with resultant tumor dissemination have limited the technique's utilization. Recent studies have shown the method to have a diagnostic accuracy (percent of neoplasms correctly categorized as benign or malignant) of approximately 95% for ovarian tumors [2-8]. The method is generally free of major complication when patients are properly selected, but severe pelvic infections have followed transvaginal or transrectal puncture of cystic ovarian neoplasms, resulting in a complication rate of about 1.6% [28]. Presently, FNA of ovarian tumors has a role in the workup of cystic lesions in young women where epithelial malignancies are unlikely and preservation of ovarian function is highly desirable. In peri- or postmenopausal women with adnexal masses, operative intervention is appropriate in most cases. Sevin and colleagues defined four clinical situations where FNA is useful [16]. These are 1) workup of primary neoplasms, 2) biopsy of superficial masses in patients with known prior disease, 3) follow-up of irradiated patients, and 4) follow-up of patients undergoing chemotherapy. From the available data, FNA has an accuracy of approximately 90% [10,18] and a low complication rate. The technique is an excellent method for the detection of recurrent or metastatic disease in patients being followed for gynecologic malignancies. When FNA is used for the investigation of newly discovered adnexal masses, patient selection is critical. FNA is helpful in carefully selected young women with cystic ovarian masses. However, its utility is limited in peri- or postmenopausal women with solid and solid-cystic adnexal masses, because these should be investigated by operative intervention.

Pelvic abscess complicating transcervical embryo transfer

A severe pelvic infection resulting in a tuboovarian abscess after transcervical embryo transfer is reported. The case is unique in that the recipient was an agonadal woman who had not undergone prior transvaginal aspiration. Although rare, pelvic infection after embryo transfer may occur in spite of normal precautions.

Comparison of Ceftriaxone (1 &amp;times; 1 g/Day) versus Cefotaxime (3 &amp;times; 1 g/Day) for Gynecologic and Obstetric Infections

A prospective, randomized clinical trial was conducted to compare the efficacy and tolerance of a single dose of 1 g ceftriaxone i.v. daily with 3 doses of 1 g cefotaxime i.v. daily for obstetric and gynecologic infections. Both agents are characterized by a wide spectrum and potent activity. Furthermore, ceftriaxone has an outstanding serum half-life of 8 h. 41 patients with pelvic inflammatory disease, pelvic or wound infections after vaginal or abdominal hysterectomy, endomyometritis and urinary-tract infection were included. Patients were monitored clinically by routine laboratory methods (erythrocyte sedimentation rate, white blood cell count and cross-reacting protein) and bacteriologically. Clinical parameters of infection were fever, local pain and/or tenderness, a sactosalpinx or pyosalpinx at palpation and cervical secretion. Clinical cure was achieved in 77.3% in the ceftriaxone and in 78.9% in the cefotaxime group, improvement in 3 (13.6%) and 4 patients (21.0%), respectively. 2 clinical failures were seen in the ceftriaxone group. One was a severe pelvic infection following vaginal hysterectomy, which responded to the addition of metronidazole, the other was due to a chlamydial salpingitis, which was cured with a 10-day course of doxycycline. Both antibiotics were well tolerated. Our results suggest that for obstetric and gynecologic infections a single 1-gram dose of ceftriaxone is equally effective as three 1-gram doses of cefotaxime.

Results following anterior levator-plasty

In this study we report about 172 patients who underwent modified anterior repair in the time from october 1983 up to april 1985 because of vaginal prolapse and/or incontinence. 125 patients could be examined clinically, in the middle 14.2 months after operation. In 64% the modified anterior repair was combined with a colporrhaphia anterior and hysterectomy, and in 20% a colporrhaphia posterior was made additionally. Dehiscence of the anterior vaginal wall occurred in 19.2%, severe pelvic infections in 8.8%. Because of bleeding complications a chirurgical intervention was necessary in 5.6%. A descent of the anterior vaginal wall was seen in 30.4%, 76.8% of the women developed a descent of the posterior vaginal wall, and 8% a stenosis of the vagina. Problems at sexual intercourse were frequent, followed by pain in the lower abdomen. The principle of the operation is presented including the changed anatomy. Many of the adverse effects can be understood and the necessity of prophylaxis of a descensus of posterior vaginal wall was described.

Intrauterine devices: malpractice and product liability.

The use of a mechanical device is an ancient and crude form of contraception. Desert dwellers in ancient Africa placed stones in the uteruses of their camels to prevent conception during long treks across the Sahara. The metal intrauterine devices (IUDs) used in the late 1800s caused severe pelvic infections that, in the absence of antibiotics, often proved fatal. The first stainless steel and polyethelene IUDs were developed around 1960, and these attained a relatively reliable degree of safety. New compositions and materials decreased the risk of infection, and innovative devices could be inserted without dilating the cervix.As mechanical means of contraception grew in popularity, pharmaceutical companies began to fight for a competitive edge, each touting the design or materials of its product as safer and niore efficient. By the mid-l970s, it is estimated, more than 15 million IUDs had been distributed throughout the world, many in developing nations.

Comparison of ticarcillin plus clavulanic acid with cefoxitin in the treatment of female pelvic infection

Ninety-three female patients with post-cesarean endometritis, post-hysterectomy pelvic cellulltis, and other miscellaneous moderately severe pelvic soft-tissue infections were treated in a randomized fashion with either ticarcillin plus clavulanic acid or cefoxitin. Of the 47 patients treated with ticarcillin plus clavulanic acid, 38 had clinical cures, four showed Improvement, therapy failed in three, and two were nonevaluable, for a failure rate of 6.7 percent. Of the 46 patients treated with cefoxitin, 33 had clinical cures, five showed improvement, therapy failed in seven, and one was nonevaluable, for a failure rate of 15.6 percent. Bacteriologically, the addition of clavulanic acid to ticarcillin was found to broaden the antibacterial spectrum to include some Escherichia coil, most Klebsiella, many coagulase-negative staphylococci, and all isolates of Staphylococcus aureus. Adverse reactions were few, with only one patient having therapy with cefoxitin discontinued because of side effects. It is concluded that ticarcillin plus clavulanic acid is quite suitable for antibiotic therapy of female pelvic soft-tissue infection, based on the (expanded) coverage of both aerobic and anaerobic bacterial species.

Using an IUD for Five or More Years May Lead to an Increased Risk of Severe Pelvic Infection

Using an IUD for Five or More Years May Lead to an Increased Risk of Severe Pelvic Infection

Using an IUD for Five or More Years May Lead to an Increased Risk of Severe Pelvic Infection

Using an IUD for Five or More Years May Lead to an Increased Risk of Severe Pelvic Infection