Ultrasound-guided transgluteal puncture and catheter drainage in the treatment of deep pelvic abscess with pelvic adhesion / 中华超声影像学杂志

Objective:To investigate the safety and efficacy of transgluteal ultrasound-guided puncture and drainage in prone position in the treatment of deep pelvic abscess with pelvic adhesion.Methods:A total of 24 cases of deep pelvic abscess with pelvic adhesion treated in the ultrasound intervention room of the First Affiliated Hospital of Zhengzhou University from October 2018 to May 2021 were selected.Ultrasound-guided puncture and drainage were performed through the buttocks. The operation time, blood loss and distal limb pain during the operation were recorded. The decreasing trend of body temperature, the white blood cell, C-reactive protein and abscess size were observed. The incidence of complications such as bleeding, pain, infection and intestinal injury were counted.Results:There were 28 abscesses in 24 patients were successfully intubated through the buttocks, the abscesses disappeared after drainage, and there were no serious complications after operation. During the follow-up of 3-22 months, there was no abscess recurrence and no long-term complications.Conclusions:Ultrasound-guided transgluteal puncture and drainage is safe and effective in the treatment of deep pelvic abscess with pelvic adhesion.

Caracterización clínica epidemiológica de pacientes con enfermedad inflamatoria pélvica tumoral / Epidemiological clinical characterization of patients with tumoral pelvic inflammatory disease

RESUMEN Introducción: La enfermedad inflamatoria pélvica es la infección grave más frecuente en mujeres entre 16 y 25 años. La adolescencia es el periodo de mayor riesgo de aparición por la mayor incidencia de factores de riesgo relacionados con conductas sexuales inseguras. Objetivo: Determinar las características clínico epidemiológicas de las pacientes con diagnóstico de enfermedad inflamatoria pélvica tumoral. Método: Se trabajó con una población de 63 pacientes. Se conformaron dos grupos de estudio, grupo I con las adolescentes y jóvenes, y grupo II con las demás pacientes. Las variables utilizadas fueron: relaciones sexuales precoces, número de parejas sexuales, relaciones sexuales desprotegidas, uso de dispositivos intrauterinos, antecedentes de interrupción de embarazo, principales manifestaciones clínicas, resultados de complementarios y tratamiento administrado. Resultados: Se encontró que el 76,4 % de las adolescentes tenían relaciones sexuales desprotegidas, 52,9 % comenzaron las relaciones sexuales antes de los 14 años, 64,7 % refirieron antecedentes de abortos provocados, y el 100 % solicitó atención por dolor pélvico. En el 95,6 % de las pacientes se utilizó tratamiento médico. Conclusiones: En la mayoría de los casos, el cuadro clínico y los complementarios realizados fueron consistentes con la enfermedad inflamatoria pélvica tumoral; y el tratamiento utilizado fue médico.

ABSTRACT Introduction: Pelvic inflammatory disease is the most frequent serious infection in women between 16 and 25 years old. Adolescence is the period of highest risk of onset due to the higher incidence of risk factors related to unsafe sexual behaviors. Objective: To determine the clinical and epidemiological characteristics of patients diagnosed with tumoral pelvic inflammatory disease. Methods: We worked with a population of 63 patients. Two study groups were formed, group I with adolescents and young people, and group II with the other patients. The variables used were: early sexual intercourse, number of sexual partners, unprotected intercourse, use of intrauterine devices, history of pregnancy termination, main clinical manifestations, complementary results, and treatment administered. Results: It was found that 76.4% of the adolescents had unprotected sexual relations, 52.9% began sexual relations before the age of 14, 64.7% referred a history of induced abortions, and 100% requested attention for pain pelvic. Medical treatment was used in 95.6% of the patients. Conclusions: In most of the cases, the clinical and complementary symptoms performed were consistent with tumor pelvic inflammatory disease; and the treatment used was medical.

Safety of Transrectal or Transvaginal Drainage of Pelvic Abscesses / Segurança da drenagem transretal ou transvaginal de abscessos pélvicos

Abstract Objective The literature on the safety and long-term sequelae of transrectal and transvaginal drainage of pelvic abscesses is limited. We evaluated the outcomes and safety of pelvic abscess drainage by interventional radiology at our institution. Methods After obtaining institutional review board approval, we retrospectively evaluated the outcomes of transrectal and transvaginal pelvic abscesses drainage using computed tomography, endorectal ultrasound, and or fluoroscopy. Results The study included 26 patients, with an age range of 24 to 88 years old, out of whom 53.8% were men. A total of 46.1% of the participants were African Americans and 26.9% were Caucasians. The average body mass index was 28.4 (range: 15.6 to 41.9). The most common etiology was penetrating abdominal injury (27%), followed by appendectomy (23%), diverticular disease (11.5%), anastomotic leak (11.5%), and disorders of gynecological causes (11.5%). The mean abscess diameter was 6.3 cm (range: 3.3 to 10.0 cm). Transrectal drainage was performed in all except one patient who had a transvaginal drainage. Transrectal ultrasound was used for drainage in 92.3% cases, and fluoroscopy was used as an additional imaging modality in 75% of the cases. An 8- or 10-Fr pigtail catheter was used in>80% of the patients. Drains were removed between 2 and 7 days in 92.3% of the cases. The average follow-up was 30.4 months (range: 1 to 107 months), and no long-term complications were reported. Only one patient required subsequent operative intervention for an anastomotic leak. Conclusions Pelvic abscess drainage by transrectal route using radiological guidance is a safe and effective procedure.

Resumo Objetivo A literatura sobre a segurança e as sequelas no longo prazo da drenagem transretal e transvaginal do abscesso pélvico é limitada. Avaliamos os resultados e a segurança da drenagem do abscesso pélvico por radiologia intervencionista em nossa instituição. Métodos Após obter a aprovação do conselho de revisão institucional, avaliamos retrospectivamente os resultados da drenagem de abscessos pélvicos transretais e transvaginais por meio de tomografia computadorizada, ultrassom endorretal, e/ou fluoroscopia. Resultados Participaram do estudo 26 pacientes, com faixa etária de 24 a 88 anos, dos quais 53,8% eram homens. Um total de 46,1% eram afro-descendentes, e 26,9% eram brancos. O índice de massa corporal médio foi de 28,4 (gama: 15,6 a 41,9). A etiologia mais comum foi lesão abdominal penetrante (27%), seguida de apendicectomia (23%), doença diverticular (11,5%), fístula anastomótica (11,5%) e distúrbios de causas ginecológicas (11,5%). O diâmetro médio do abscesso foi de 6,3 cm(gama: 3,3 a 10,0 cm). A drenagem transretal foi realizada em todos os pacientes, com exceção de uma, que foi submetida a uma drenagem transvaginal. A ultrassonografia transretal foi utilizada para drenagem em 92,3% dos casos, e a fluoroscopia como modalidade adicional de imagem, em 75% dos casos. Um catéter duplo J de 8 ou 10 Fr foi usado em>80% dos pacientes. Os drenos foram retirados entre 2 e 7 dias em 92,3% dos casos. O acompanhamentomédio foi de 30,4meses (gama: 1 a 107 meses), e nenhuma complicação de longo prazo foi relatada. Apenas um paciente necessitou de intervenção cirúrgica subsequente para um vazamento anastomótico. Conclusão A drenagem do abscesso pélvico por via transretal com orientação radiológica é um procedimento seguro e eficaz.

Report of 9 cases of pelvic abscess complicated with septic shock / 中国感染与化疗杂志

Objective To investigate the clinical characteristics,diagnosis and treatment of pelvic abscess complicated with septic shock.Methods The clinical symptoms,laboratory tests,surgical procedures,and prognosis were analyzed retrospectively for 9 patients with pelvic abscess complicated with septic shock.All the patients were treated in the Second Affiliated Hospital of Soochow University from August 2009 to March 2017.Results High fever and abdominal pain were reported in all the 9 patients,associated with hypotension,cardiac,pulmonary and renal dysfunction,and other symptoms.Eight patients were referred to ICU after early volume resuscitation,antimicrobial treatment,surgery or puncture.These 8 patients finally survived.The remaining one patient experienced multiple organ failure,disseminated intravascular coagulation,and extensive bleeding during treatment,and died finally.Conclusions Early diagnosis,adequate volume resuscitation,antimicrobial therapy,appropriate vasoactive drugs,and timely surgical removal of abscess are important for improving the survival of patients with pelvic abscess and septic shock.

Clinical analysis of laparoscopy combined with deep hyperthermia in the treatment of pelvic absces / 中国基层医药

Objective To explore the clinical effect of laparoscopy combined with deep hyperthermia in the treatment of pelvic abscess.Methods Clinical data of 56 patients with pelvic abscess treated by laparoscopy combined with deep hyperthermia were retrospectively analyzed.Results 56 cases were completed in laparoscopic surgery,before surgery,after diagnostic accordance rate was 76.8%,average operation time was 51 minutes,postoperative average hospitalization was 5.1 days.After operation they were performed in vitro hyperthermia to increase the efficacy. Patients were followed up for 6 months,no recurrence.32 patients with fertility requirements of the fallopian tube,1 to 3 months after the operation of bilateral fallopian tube radiography,20 cases of patency,8 cases of tubal patency and poor.Conclusion Laparoscopy combined with deep hyperthermia in vitro is an ideal and safe treatment,which is conducive to protect the patients'reproductive function,especially for young patients with no pregnancy.

Utilidad de la ecografia en manos del cirujano para el drenaje percutáneo de los abscesos abdominales y pélvicos / Utility of ultrasound in the hands of the surgeon in percutaneous drainage of abdominal and pelvic abscess

Antecedentes: los abscesos o colecciones abdominopélvicas sintomáticas se caracterizan por ser una entidad clínico-quirúrgica de origen multifactorial, aunque casi siempre su etología es posoperatoria. Objetivo: describir la aplicabilidad y eficacia del drenaje percutáneo de colecciones abdominales y pelvianas, bajo guía ecográfica, en un servicio de cirugía. Material y métodos: en un período de 9 años se incluyeron todos los pacientes con colecciones ab-dominopelvianas tratados en forma consecutiva con drenaje percutáneo bajo guía ecográfica, en el Hospital Italiano de Bahía Blanca. Resultados: desde junio de 2003 hasta junio de 2012 se trataron 87 pacientes con colecciones abdomi-nopelvianas sintomáticas; en 79 de ellos el tratamiento fue realizado bajo guía ecográfica; 4 pacientes no fueron incluidos en el estudio debido a que el tratamiento se realizó bajo guía tomográfica, y los restantes 4 fueron descartados porque eran pacientes pediátricos. En 51 (64,5%) de ellos, el origen fue posoperatorio. Treinta y ocho (48,1%) pertenecían al sexo femenino. El promedio de edad fue 55 años (rango 18-92). El drenaje se realizó bajo guía ecográfica y radioscópica en 78 pacientes (98,7%) y en uno el abordaje fue ecográfico y laparoscópico. En 15 pacientes (18,9%) se presentaron complicaciones inherentes al procedimiento: 7 pacientes cursaron con febre, 3 refrieron dolor luego de la intervención (abordaje intercostal), en 3 se constataron equivalentes febriles, en una, celulits, y en otra, fistula de colon. De acuerdo con la Clasificación de Dindo-Clavien: 14 puntos Grado I (93,3%) y 1 punto Grado III B (6,7%). No hubo mortalidad asociada al procedimiento; 7 pacientes (8,8%) fallecieron por causas no relacionadas con este. La técnica fue resolutiva en 70 pacientes (88,6%) y satsfactoria en 74 (94%). Conclusiones: el drenaje percutáneo de las colecciones abdominales y pélvicas bajo guía ecográfica en manos del cirujano fue factble y eficaz, lo que la convierte en una técnica segura con baja morbilidad y nula mortalidad.

Background: abscesses or symptomatic abdominal collectons have multifactorial origin, although in more than 65% of the cases, the etology is postoperative. Objective: to describe the applicability and utility of abdominal and pelvic percutaneous drainage guided by ultrasound in a surgical team. Methods: a series of consecutive patents with ultrasound guided percutaneous drainage of abdominal or pelvic collecton performed during in a 9 year period. Results: from June 2003 to June 2012, 87 procedures were performed, 79 of them guided with ultrasound.The etology was postoperative in 51 patents (64.5%). Thirty eight (48.1 %) were female. Average age was 55 (range 18-92). Drainage was performed under ultrasound and radiology guide in 78 patents (98.7%) and by laparoscopic and ultrasound guide in one patent. Fifeen patents (18.9%) presented morbidity related to the procedure: fever in 7 patents, unusual pain in 3 (all with intercostal drainage), chills and sweating in 3, cellulits in one, and a colonic leak in one. All patents were included into of Dindo-Clavien Classificaton of Surgical Complicatons and the results were: Grade I: 14 patents, Grade IIIb: one patent. There was no mortality related to the procedure; seven patents (8.8%) died because of other causes. The overall success rate was 88.6 % (70 cases), and satsfactory in 94% (74 cases). Conclusions: in surgeons hands, ultrasound guided percutaneous drainage of abdominal and pelvic collectons was a feasible, efective and safe procedure with low morbidity.

Unusual Complication of Incarcerated Uterovaginal Prolapse: A Case Report.

Aims: The case report aims to bring out a rare and life threatening complication of incarcerated utero-vaginal prolapse. Case Report: We present a case of 55 yr old woman with incarcerated prolapse. Details of evolving clinical features and investigations that led to the suspicion of pelvic abscess are presented and discussed. Emergency intervention by colpotomy for draining the abscess was performed. Definitive surgery was performed 1 month after she fully recovered and the tissue edema and congestion subsided. Two stage management of the case is detailed. Conclusion: Spontaneous pelvic abscess is a rare but life threatening complication of incarcerated prolapse. A two stage surgery in such a situation is associated with good outcome.

Comparative analysis of different treatment option of pelvic abscess / 中华全科医师杂志

A total of 78 pelvic abscess cases were confirmed by operation retrospectively.Group A underwent celiotomy ( n =30 ) while group B laparoscopic surgery ( n =48 ).Medical history , clinical symptoms and outcomes were analyzed.Operative durations of groups A and B were ( 90 ±21 ) and ( 70 ± 14) min, the amount of hemorrhage (70 ±24) and (46 ±24) ml and wound dehiscence rate 20% and 0 respectively.There was significant inter-group difference.And the efficacy of group B was better than that of group A.The postoperative recurrence rate was 13% and 4% and there was no significant difference.Laparoscopic surgery is suitable for treating pelvic abscess.It is mini-invasive, has a quick recovery and does not increase operative complications.

Manejo laparoscópico de la enfermedad pélvica inflamatoria severa: reporte de tres casos y revisión de la literatura / Laparoscopic management of severe pelvic inflammatory disease: a report of three cases and a literature review

Objetivo: hacer una revisión de la literatura sobre la utilidad de la laparoscopia en el tratamiento del absceso tubovárico en términos de mejoría, estancia y fertilidad posterior. Materiales y métodos: se presentan tres casos de pacientes con enfermedad pélvica inflamatoria severa que consultaron a una institución privada de referencia ubicada en Medellín (Colombia), a quienes se les practicó una laparoscopia operatoria, además de la administración de un antibiótico parenteral como manejo. Se realizó una búsqueda en la base de datos Medline vía PubMed con las palabras clave: “tubo-ovarian abscess, treatment, laparoscopy, fertility”. Se realizó además una búsqueda de textos clásicos y guías de manejo. Resultados: se encontraron 49 artículos de los cuales 13 eran relevantes al problema en cuestión. De estas publicaciones, 8 eran artículos de revisión, 4 series de casos, y 1 un estudio de cohortes retrospectivas. Conclusión: el manejo laparoscópico conservador del absceso tubovárico en el período inicial de la enfermedad, adicional a los antibióticos, surge como una alternativa que podría mejorar los resultados a corto y largo plazo. Se requieren estudios de alta calidad que respalden esta observación...

Objective: carrying out a literature review about the usefulness of laparoscopy in treating tubo-ovarian abscesses in terms of improvement, hospital stay and subsequent fertility.Materials and methods: three cases of patients suffering from severe pelvic inflammatory disease are presented; they consulted at a private reference institution in Medellín, Colombia, and were then submitted to laparoscopy, accompanied by parenteral antibiotics as management. A search was made in the Medline database via PubMed using the following key words: “tubo-ovarian abscess, treatment, laparoscopy, fertility.” A search was also made in classical texts on the subject and management guidelines. Results: 49 pertinent articles were found, of which 13 were relevant to the matter in hand; 8 were review articles, 4 were case-series and 1 was a retrospective cohort study. Conclusion: conservative laparoscopic management of tubo-ovarian abscess during the disease’s initial period, accompanied by the appropriate antibiotic regime, emerged as an alternative which could improve short- and long-term results. High-quality studies are thus needed to confirm such observation...

The Clinical Study of Abdominopelvic Actinomycosis

PURPOSE: Abdominal actinomycosis is a rare chronic suppurative infectious disease, caused by a gram-positive bands Actinomyces israelii organism. The pathogens produces a characteristic granulomatous inflammatory fibrosis and mass lesion. Actinomycosis is usually divided into three clinical types; cervicofascial, thoracic and abdominopelvic. This study was designed to investigate the clinical or radiologic variability and the meanings of the diagnostic differentiality of abdominopelvic actinomycosis when patients present with an unusual abdominal mass or abscess. METHODS: The medical records of 19 patients treated at the Departments of Surgery and Obstetrics and Gynecology, Dong-A University Hospital were reviewed. The clinical characteristics, diagnostic evaluation and surgical treatment results were retrospectively analyzed. RESULTS: Of the 19 patients, 7 cases involved the colon and 11 the uterus and ovary with one case also involving the retroperoneum and ureter. Most cases (84.2%) had predisposing factors of disease progression, including intrauterine device (IUD), abortion, previous surgery, appendicitis and diverticulitis. The common presentations of the patients were abdominal pain (57.8%) and a palpable mass (15.7%). Preoperatively, no case was diagnosed as actinomycosis, but misconceived as a pelvic abscess, ovarian or colon cancers, a mesenteric origin mass, a lymphoma, periappendiceal abscess, acute appendicitis, uterine myoma, dysfunctional uterine bleeding or endometriosis. Explorations were performed in all patients. Eighteen cases were cured following surgery with subsequent antibiotics. However, one case recurred due to incompletion of antibiotics following surgical drainage. CONCLUSION: Abdominopelvic actinomycosis should be included as a differential diagnosis when an unusual abdominal mass presents on abdominal CT or ultrasound. Appropriate antibiotics, as well as surgery, are important in the treatment of abdominopelvic actinomycosis.

A Case of Pelvic Abscess Due to the Perforated Appendicitis / 대한비뇨기과학회지

The pelvic abscess communicating with the appendix is relatively rare, however, it could be diagnosed preoperatively by various diagnostic modalities such as ultrasonography, computed tomography or laparoscopy. We experienced a case of pelvic abscess presented as a pelvic mass invading vesical wall, and report this unusual presentation with a brief review of literature.

Pathogenic Analysis of Pelvic and Peritoneal Abscess and Its Clinical Management / 中华医院感染学杂志

OBJECTIVE To explore the pathogenesis of pelvic and peritoneal abscesses and their clinical(management).METHODS Clinical data of 109 patients with pelvic and peritoneal abscesses between 1999 and 2005 were retrospectively(evaluated).The connection of their pathogenesis,antibiotics choice,and treatment types with(prognoses) was analyzed.RESULTS Pus from all patients was collected and sent to do germ culture and antibiotic susceptibility testing.Seventy five cases were with positive germ culture.The most germs were Escherichia coli and meropenem and amikacin were considered effective.Four cases were relapsed after surgery from 90 cases.(Pelvic) abscess drainage was performed through vagina under B type ultrasound guiding in 9 cases.Conservative treatment was given in 10 cases and no patient died.CONCLUSIONS Pelvic and peritoneal abscesses should be treated early with antibiotic according susceptibility testing to make a choice.And surgery or sufficient abscess drainage can(improve) their prognosis.