Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 12 , ISSUE 1 ( January-February, 2020 ) > List of Articles

Original Article

Management of Pelvic Abscess—Challenges for a Gynecologist

Anirudha R Podder

Citation Information : Podder AR. Management of Pelvic Abscess—Challenges for a Gynecologist. J South Asian Feder Obs Gynae 2020; 12 (1):10-17.

DOI: 10.5005/jp-journals-10006-1742

License: CC BY-NC 4.0

Published Online: 02-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objectives: To analyze the difficulties in diagnosis, treatment, and postoperative care in patients with pelvic abscess. Study design: This is an observational study; 11 patients underwent laparotomy for drainage of pelvic abscess between January 1, 2015, and December 31, 2018. The diagnosis of pelvic abscess was a spot diagnosis only in one patient. It was a surprise finding, on table, in three patients. The most common confounding diagnosis was ovarian torsion. Two patients had subacute intestinal obstruction like clinical features. Results: All patients improved following laparotomy and drainage of pus. In the first six patients in our series, the skin was closed immediately following closure of the rectus sheath, and all of them developed wound dehiscence. In the last five patients in our series, delayed primary closure was performed. The skin was closed after wound turned healthy and comorbid conditions controlled and corrected. All five patients had a healthy scar. The shortest duration of hospital stay was 18 days, and the longest duration of hospital stay was 55 days. Conclusion: Pelvic abscess is one condition which can test the clinical acumen of a gynecologist to make a prompt and correct diagnosis and to manage multiple postoperative problems like uncontrolled diabetes, sepsis, and a wound which will require daily dressing for several days. This is one of the few gynecological conditions where a delayed primary closure should be performed. And most importantly, the gynecologist has to manage spiraling treatment costs and a falling patient morale.

  1. Mitchell C, Prabhu M. Pelvic inflammatory disease: current concepts in pathogenesis, diagnosis and treatment, infectious disease clinics of North America. Infect Dis Clin North Am 2013;27(4):793–809. DOI: 10.1016/j.idc.2013.08.004.
  2. Chappel CA, Weisenfeld HC. Pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and tuboovarian abscess. Clin Obstet Gynecol 2012;55(4):893–903. DOI: 10.1097/GRF.0b013e3182714681.
  3. Sato K, Kajihara T, Miki A, et al. Differential diagnosis of pelvic cystic lesions caused by hemorrhage from inflammatory abscess using CT attenuation in women with acute abdomen. Nagoya J Med Sci 2015;77(4):563–569.
  4. Hirasawa H, Oda S, Nakamura M. Blood glucose control in patients with severe sepsis and septic shock. World J Gastroenterol 2009;15(33):4132–4136. DOI: 10.3748/wjg.15.4132.
  5. Thomassin-Naggaraa I, Darai E, Bazota M. Gynecological pelvic infection: what is the role of imaging? Diagn Interv Imaging 2012;93(6):491–499. DOI: 10.1016/j.diii.2012.04.002.
  6. Aimakhu CO, Olayemi O, Odukogbe AA. Surgical management of pelvic abscess: laparotomy versus colpotomy. J Obstet Gynaecol 2003;23(1):71–72. DOI: 10.1080/0144361021000043317.
  7. Oride A, Kanasaki H, Miyazaki K. Therapeutic process of gynecological pelvic abscess—retrospective review of 20 cases. Surgical Science 2013;4(03):202–209. DOI: 10.4236/ss.2013.43038.
  8. Mathai M, Sanghvi H, Guidotti RJ, et al. Managing Complications in Pregnancy and Childbirth. A guide for midwives and doctors, Culdocentesis and Colpotomy, Section 3, Procedures, WHO International, Department of Reproductive Health and Research. World Health Organization; 2000.
  9. Chiang RA, Chen SL, Tsai YC. Delayed primary closure versus primary closure for wound management in perforated appendicitis: a prospective randomized controlled trial. J Chin Med Assoc 2012;75(4):156–159. DOI: 10.1016/j.jcma.2012.02.013.
  10. Verdam FJ, Dolmans DEJGJ, Loos MJ, et al. Delayed primary closure of the septic open abdomen with a dynamic closure system. World J Surg 2011;35(10):2348–2355. DOI: 10.1007/s00268-011-1210-8.
  11. van't Riet M, Steyerberg EW, Nellensteyn J, et al. Meta-analysis of techniques for closure of midline abdominal, incisions. Br J Surg 2002;89(11):1350–1356. DOI: 10.1046/j.1365-2168.2002.02258.x.
  12. Sartelli M. A focus on intra-abdominal infections. World J Emerg Surg 2010;5(1):9. DOI: 10.1186/1749-7922-5-9.
  13. Kaveeshwar SA, Cornwall J. The current state of diabetes mellitus in India. Australas Med J 2014;7(1):45–48. DOI: 10.4066/AMJ.2014.1979.
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