Pelvic abscess is a collection of pus in the

pelvis The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The ...

, typically occurring following lower abdominal surgical procedures, or as a complication of

pelvic inflammatory disease Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis. Often, there may be no ...

(PID),

appendicitis Appendicitis is inflammation of the appendix. Symptoms commonly include right lower abdominal pain, nausea, vomiting, and decreased appetite. However, approximately 40% of people do not have these typical symptoms. Severe complications of a rup ...

, or lower genital tract infections. Signs and symptoms include a high

fever Fever, also referred to as pyrexia, is defined as having a body temperature, temperature above the human body temperature, normal range due to an increase in the body's temperature Human body temperature#Fever, set point. There is not a single ...

, pelvic mass, vaginal bleeding or discharge, and lower

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

. It can lead to sepsis and death. Blood tests typically show a raised white cell count. Other tests generally include

urine pregnancy test A pregnancy test is used to determine whether a female is pregnant or not. The two primary methods are testing for the female pregnancy hormone (human chorionic gonadotropin (hCG)) in blood or urine using a pregnancy test kit, and scanning with u ...

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...

and exudate culture, and

vaginal wet mount A vaginal wet mount (or vaginal smear20% of the epithelial cells are clue cells (the single most reliable predictor) ::*Discharge is thin and homogeneous ::*Sample smells fishy when mixed with potassium hydroxide ("whiff test") ::*Vaginal pH is >4 ...

Ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

CT-scan A computed tomography scan (CT scan; formerly called computed axial tomography scan or CAT scan) is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers ...

or MRI may be used to locate the abscess and assess its dimensions. Treatment is with

antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

and drainage of the abscess; typically guided by

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

or CT. Endoscopic ultrasound (EUS) is a minimally invasive alternative method.

Signs and symptoms

Signs and symptoms include a high

, pelvic mass, vaginal bleeding or discharge, and lower

. There may be urinary frequency,

diarrhoea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

, or persistent feeling of needing to pass stool. Other symptoms may include fatigue, nausea, and vomiting. Clinical features might not be apparent until the pelvic abscess has grown in size. The lower abdomen is generally tender; one or both sides. A bulging of the front wall of the rectum might be felt on digital examination via the rectum or vagina. Complications include sepsis and peritonitis. In the longterm, a fistula may develop.

Cause and mechanism

Pelvic abscess typically occurs following gynecological surgery and

abdominal surgery The term abdominal surgery broadly covers Surgery, surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, l ...

; hysterectomy, laparotomy, caesarian section, and induced abortion. It may occur as a complication of

(PID),

diverticulitis Diverticulitis, specifically colonic diverticulitis, is a gastrointestinal disease characterized by inflammation of abnormal pouches—diverticula—which can develop in the wall of the large intestine. Symptoms typically include lower abdominal ...

inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...

(IBD), trauma, pelvic organ cancer, or lower genital tract infections. The abscess may be in the pouch of Douglas,

fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the ovaries. The fallopian tubes are part of the female reproductive system. In ot ...

ovary The ovary is an organ in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary () found on each side of the body. ...

, or parametrium. It begins as inflammation or a collection of blood in the pelvis. Other risk factors include immunodeficiency, pregnancy,

hydrosalpinx A hydrosalpinx is a condition that occurs when a Fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus). The blocked tube may become substantially distended giving the tube a characteristic sausage-li ...

endometrioma Endometrioma is the presence of tissue similar to, but distinct from, the endometrium in and sometimes on the ovary. It is the most common form of endometriosis. Endometrioma is found in 17–44% patients with endometriosis. More broadly, endometr ...

, poorly controlled

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

, and genital tract abnormalities. Opening the rectum to resect a rectal cancer may lead to developing a pelvic abscess.

Females

PID in females may lead to a

tubo-ovarian abscess A tubo-ovarian abscess (TOA) is one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined pocket of pus with defined ...

, where the abscess may be in the

Children

In children, it is more frequently associated with IBD and appendicitis.

Diagnosis

Blood tests typically show a raised white cell count, often with a high ESR and C-reactive protein. Other tests generally include

and exudate culture, and

Medical imaging Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to rev ...

to assess the dimensions and locate the abscess may include

or MRI.

Differential

Other conditions that appear similar include

ectopic pregnancy Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. ...

, PID, appendicitis, kidney stone,

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Eith ...

, and sepsis following

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...

termination of pregnancy Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnan ...

Treatment

Treatment is with

and drainage of the abscess; typically guided by

or CT, through the skin, via the rectum, or transvaginal routes. Occasionally antibiotics may be used without surgery; if the abscess is at a very stage and small. Until sensitivities are received, a broad spectrum antibiotic is generally required. Sometimes, a laparotomy of laparoscopy is required. Endoscopic ultrasound (EUS) is a minimally invasive alternative method. Treatment also includes adequate hydration. Further surgery such as is sometimes required to treat the underlying cause; such as salpingo-oophorectomy for tubo-ovarian abscess.

Outcome

Pelvic abscess responds well to antibiotics and hydration. The outcome is less successful in the presence of fistula.

Epidemiology

It is uncommon. The incidence of pelvic abscess is less than 1% in an individual undergoing obstetric and gynecological operative procedure.

References

{{medical resources , ICD11 = {{ICD11, DC50.2 , ICD10 = {{ICD10, K65.0, {{ICD10, N73 General surgery Pelvis