AUTHORS: Ella Stern, MD, and Marwan Maayeh, MD
DefinitionPelvic abscess is an acute or chronic infection, most commonly involving the pelvic viscera. Treatment requires directed therapy including broad-spectrum antimicrobials and, if medical therapy fails, surgical intervention. There are four categories based on etiologic factors:
- Ascending infection, spreading from cervix through endometrial cavity to adnexa, forming a tuboovarian complex
- Infection occurring in the puerperium, which spreads to the adnexa from the endometrium or myometrium by a hematogenous or lymphatic route
- Abscess complicating pelvic surgery
- Involvement of the pelvic viscera as a result of spread from contiguous organs, such as appendicitis or diverticulitis
Synonyms
- Tuboovarian abscess (TOA)
- Vaginal cuff abscess
ICD-10CM CODES | K63.0 | Abscess of intestine | K65.1 | Peritoneal abscess | K68.11 | Postprocedural retroperitoneal abscess | K68.12 | Psoas muscle abscess | K68.19 | Other retroperitoneal abscess | N70.93 | Salpingitis and oophoritis, unspecified | N70.0 | Acute salpingitis and oophoritis | N70.1 | Chronic salpingitis and oophoritis |
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Epidemiology & DemographicsIncidence
- 34% of hospitalized patients with pelvic inflammatory disease
- <1% of patients undergoing hysterectomy, most frequently with vaginal approach
- Peak incidence between 15 and 40 yr
Risk FactorsSame risk factors as for pelvic inflammatory disease, although in 30% to 50% of patients there is no prior history of salpingitis before abscess forms.
Physical Findings & Clinical Presentation
- Abdominal or pelvic pain (90%)
- Fever or chills (50%)
- Abnormal bleeding (21%)
- Vaginal discharge (28%)
- Nausea (26%)
- Up to 60% to 80% present without fever or leukocytosis; absence of these findings should not exclude diagnosis
Etiology
- Mixed flora of anaerobes, aerobes, and facultative anaerobes, such as Escherichia coli, Bacteroides fragilis, Prevotella spp., aerobic streptococci, and Peptococcus and Peptostreptococcus spp.
- Neisseria gonorrhoeae and Chlamydia are the major etiologic bacteria in cervicitis and salpingitis but are rarely found in abscess cavity cultures.
- In elderly patients consider diverticular disease.