A pelvic abscess is the walled-off collection of infected fluid that forms as a frequent complication of untreated infections. In genital tract infections, an abscess is the end-stage progression and has a good prognosis depending upon its location. This can be found anywhere in the pouch of Douglas, fallopian tubes, parametric tissues, or ovaries.
Symptoms of pelvic abscess
- Severe pelvic pain
- Deep tenderness on one or both sides
- Urinary urgency and frequency
- Fever and vomiting
- Rigors and chills
- Vaginal discharge for abnormal vaginal bleeding
- Foul-smelling discharge
- Rectal discharge containing mucus
Causes of pelvic abscess
An abscess develops due to the buildup of necrotic tissue around the infective exudate, forming a thick fibrous wall. The thick fibrous wall does not allow any antimicrobial agent to enter this circumscribed collection of infective exudate, thus build up of puss inside, forming a pustule. The infection develops as a result of an imbalance between host defense mechanisms and bacterial virulence. The bacterial virulence can be caused by several factors:
- Pelvic inflammatory disease, in which an ascending infection from the vagina spreads to the uterus, fallopian tubes, and sometimes up to the peritoneum. This causes edema in the fallopian tube and endothelial damage, consequently blocking the tubes.
- Pelvic abscess also develops after any sort of surgical procedure. Blood, lymphatic debris, and serum often accumulate in the pelvis allowing bacterial growth. The infection occurs via skin contamination, consequently developing into an abscess.
- Inflammatory bowel disease due to actinomycosis bacteria is another cause of abscess formation. This often develops after intrauterine contraceptive device placement, surgery, or trauma.
- Untreated diverticulitis can also complicate forming an abscess which can further penetrate and lead to peritonitis.
Location of pelvic abscess
In females, abscess forms between the uterus and posterior fornix of the vagina. A tubo-ovarian abscess is a specific type of pelvic abscess that develops in females of reproductive age as a complication of PID, occupying the ovary and fallopian tube.
In males, a it is located between the bladder and rectum.
The predisposing factors are:
- Immune deficiency syndromes
- Crohn’s disease
- Inflammatory bowel disease
- Surgical procedures
Complications of pelvic abscess
And untreated or mistreated pelvic abscess can lead to several complications:
- Persistent fever
- Suspicion of a ruptured abscess
- Sepsis or septic shock
- Ectopic pregnancy due to formation of scar tissue followed by healing of an abscess
- Pelvic adhesions formation
- Chronic pelvic pain due to adhesion formation
Management of pelvic abscess
Timely management is very important, as this can easily develop into life-threatening situations if left untreated.
To treat a pelvic abscess, a definitive diagnosis is mandatory, for this your doctor will take a detailed history of your symptoms followed by pelvic examination. A series of investigations are run to confirm the diagnosis:
- Blood complete picture to look for raised white cell count
- High C-reactive protein levels in the blood
- Culture of contents of the abscess
- Urine pregnancy test to rule out an ectopic pregnancy
- Pelvic ultrasound to look for the exact location and adjacent structures
- CT scan to look for the origin of abscess and treat the underlying cause
An abscess can be treated by medical as well as surgical treatment depending upon the severity of the condition.
- Broad-spectrum antibiotic combination against gram-positive and gram-negative bacteria.
- Over-the-counter pain killers for pain relief
- Antibiotic therapy is also continued as follow up treatment after surgical treatment
- Incision and drainage of pelvic abscess followed by antibiotic therapy in case of a small abscess
- Image-guided drainage for abscesses that are present at odd locations
This can be done by 3 methods, namely;
- Ultrasound-guided aspiration of the abscess through the vagina in females and rectum in males
- Endoscopic ultrasound-guided drainage is the least invasive procedure
- CT guided aspiration and drainage uses a Trans-gluteal percutaneous approach which sometimes also include placement of a drainage catheter
Laparoscopic drainage in complicated cases
When to consult a doctor?
If you start feeling unusual changes in your bowel habit or urinary pattern which is accompanied by fever, nausea, or any other sign of toxicity, you should consult your physician as soon as possible.
Is pelvic abscess visible on ultrasound?
Pelvic ultrasound is the first-line diagnostic tool to assess a pelvic abscess.
How serious is a pelvic abscess?
Abscess if left untreated can rupture spilling its toxic and infective content in the structures nearby, promoting bacterial growth that may also develop into sepsis, which is a life-threatening condition.
What is the most common cause of pelvic abscess in females?
Females with pelvic inflammatory disease often come with a pelvic abscess as its complication.