Therapeutic Process of Gynecological Pelvic Abscess— Retrospective Review of 20 Cases

Aki Oride, Haruhiko Kanasaki, Kohji Miyazaki

Department of Obstetrics and Gynecology, School of Medicine, Shimane University, Izumo, Japan.

DOI: 10.4236/ss.2013.43038                

Abstract

Background: Conservative therapies of pelvic abscess are not highly effective and surgical treatment is usually required. This study reviewed cases of pelvic abscess treated at our hospital over a 3-year period to evaluate treatment efficacy. The medical records of 20 patients diagnosed with pelvic abscess and admitted to our hospital for treatment between November 2006 and December 2009 were retrospectively examined. Results: Mean age of the patients was 50 ± 16.6 years. Pelvic abscess occurred spontaneously in 13 patients and secondary to surgical manipulation in 7 patients. In the 13 patients with spontaneous abscess, 7 had undergone pelvic surgery and 2 had undergone insertion of an intrauterine contraceptive device. Concomitant endometriosis was present in 5 of the 13 (38.5%) patients. A positive bacterial culture from the abscess was obtained in 16 of 19 (84.2%) patients tested. Causative bacteria included 4 aerobic bacterial species detected in 7 patients and 11 anaerobic bacterial species detected in 10 patients. Although multiple antibiotics were administered in all cases, 19 of the 20 (95%) patients eventually required surgical intervention, which included total hysterectomy plus adnexectomy, drainage under laparotomy or drainage alone. Anaerobic bacteria were frequently detected as the causative bacteria. Conclusion: As treatment with antibiotics alone was ineffective in almost all cases, surgical treatment was required. Drainage might be the first-choice treatment for pelvic abscess to avoid invasive surgery.

Keywords

Pelvic Abscess; Tubo-Ovarian Abscess; Endometrioma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	S. Granberg, K. Gjelland and E. Ekerhovd, “The Management of Pelvic Abscess,” Best Practice and Research Clinical Obstetrics and Gynaecology, Vol. 23, No. 5, 2009, pp. 667-678. doi:10.1016/j.bpobgyn.2009.01.010
[2]	D. V. Landers and R. L. Sweet, “Tubo-Ovarian Abscess: Contemporary Approach to Management,” Reviews of Infectious Disesase, Vol. 5, No. 5, 1983, pp. 876-884. doi:10.1093/clinids/5.5.876
[3]	S. Osser, B. Gullberg, P. Liedholm and N. O. Sjoberg, “Risk of Pelvic Inflammatory Disease among IntrauterineDevice Users Irrespective of Previous Pregnancy,” Lancet, Vol. 1, No. 8165, 1980, pp. 386-388. doi:S0140-6736(80)90942-3 [pii]
[4]	R. Mirhashemi, W. M. Schoell, R. Estape, R. Angioli and H. E. Averette, “Trends in the Management of Pelvic Abscesses,” Journal of the American College Surgeons, Vol. 188, No. 5, 1999, pp. 567-572.
[5]	S. G. McNeeley, S. L. Hendrix, M. M. Mazzoni, D. C. Kmak and S. B. Ransom, “Medically Sound, Cost-Effective Treatment for Pelvic Inflammatory Disease and Tuboovarian Abscess,” American Journal and Obstetrics and Gynecology, Vol. 178, No. 6, 1998, pp. 1272-1278.
[6]	P. R. Rubenstein, D. R. Mishell Jr. and W. J. Ledger, “Colpotomy Drainage of Pelvic Abscess,” Obstetrics and Gynecology, Vol. 48, No. 2, 1976, pp. 142-145.
[7]	K. Gjelland, E. Ekerhovd and S. Granberg, “Transvaginal Ultrasound-Guided Aspiration for Treatment of TuboOvarian Abscess: A Study of 302 Cases,” American Journal of Obstetrics and Gynecology, Vol. 193, No. 4, 2005, pp. 1323-1330. doi:10.1016/j.ajog.2005.06.019
[8]	T. Perez-Medina, M. A. Huertas and J. M. Bajo, “Early Ultrasound-Guided Transvaginal Drainage of Tubo-Ovarian Abscesses: A Randomized Study,” Ultrasound in Obstetrics and Gynecology, Vol. 7, No. 6, 1996, pp. 435-438. doi:10.1046/j.1469-0705.1996.07060435.x
[9]	J. Henry-Suchet, “Laparoscopic Treatment of Tubo-Ovarian Abscess: Thirty Years’ Experience,” Journal of the American Association of Gynecologic Laparoscopists, Vol. 9, No. 3, 2002, pp. 235-237. doi:10.1016/S1074-3804(05)60395-7
[10]	C. C. Yang, P. Chen, J. Y. Tseng and P. H. Wang, “Advantages of Open Laparoscopic Surgery over Exploratory Laparotomy in Patients with Tubo-Ovarian Abscess,” Journal of the American Association of Gynecologic Laparoscopists, Vol. 9, No. 3, 2002, pp. 327-332. doi:10.1016/S1074-3804(05)60412-4
[11]	A. G. Protopapas, E. S. Diakomanolis, S. D. Milingos, A. J. Rodolakis, S. N. Markaki, G. D. Vlachos, D. E. Papadopoulos and S. P. Michalas, “Tubo-Ovarian Abscesses in Postmenopausal Women: Gynecological Malignancy until Proven Otherwise?” European Journal of Obstetrics, Gynecology, and Reproductive Biology, Vol. 114, No. 2, 2004, pp. 203-209. doi:10.1016/j.ejogrb.2003.10.032
[12]	I. Grammatikakis, N. Evangelinakis, G. Salamalekis, V. Tziortzioti, C. Samaras, C. Chrelias and D. Kassanos, “Prevalence of Severe Pelvic Inflammatory Disease and Endometriotic Ovarian Cysts: A 7-Year Retrospective Study,” Clinical and Experimental Obstetrics and Gynecology, Vol. 36, No. 4, 2009, pp. 235-236.
[13]	T. Kubota, K. Ishi and H. Takeuchi, “A Study of TuboOvarian and Ovarian Abscesses, with a Focus on Cases with Endometrioma,” Journal of Obstetrics and Gynaecology Researcl, Vol. 23, No. 5, 1997, pp. 421-426.