PELVIC ABSCESS

PELVIC ABSCESS


Pelvic abscess

  • MC site of an intraperitoneal abscess
  • Diarrhea and passage of mucus in stools
  • Rectal examination: bulging of anterior rectal wall
  • Majority of abscesses burst into the rectum and rapid recovery follows
  • In women, vaginal drainage through posterior fornix is chosen
  • Rectal drainage is preferable over suprapubic drainage
  • Laparotomy is never necessary 
Left subphrenic space Right subphrenic space
Causes of abscess

  • Surgery on the stomach, tail of the pancreas, spleen or splenic flexure of the colon
Causes of abscess

  • Perforating cholecystitis
  • Perforated duodenal ulcer
  • Appendicitis
  • Duodenal cap blow-out following gastrectomy
Left subhepatic space/lesser sac Right subhepatic space
  • Commonest cause of infection is complicated acute pancreatitis
  • Deepest space of the four
  • Commonest site of a subphrenic abscess which arises from appendicitis, cholecystitis, perforated DU, following upper abdominal surgery
 

Clinical features 

  • Pus some-where, pus no-where else, pus under the diaphragm
  • Plain X-ray: elevated diaphragm (tented diaphragm)
  • USG or CT is the investigation of choice
  • Radiolabelled white cell scanning when other techniques have failed

Exam Important

  • Vaginal drainage of a pelvic abscess (posterior colpotomy) is indicated when a pelvic abscess extends into the pouch of Douglas.
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