Dr. Rahul Manchanda
Dr. K. V. Mahalakshmi
24 year old “X” married for less than a month, presented to the outpatients with pain abdomen, cough and high grade fever. She had periods which were painful and heavy.
She was put on Ceftum.
Physical examination revealed that her chest was clear and her pelvic examination was suggestive of an acutely tender fullness in her POD. She was ordered all routine and specific investigations which showed her counts were raised to 15,700.
The USG and CT findings suggested a cystic area in the right ovary with dense coarse in- homogenous echoes with the ovary measuring 6 x 4 x 4 cm with an increased ovarian volume of 82 ml.
Symptoms including fever did not remit, still recording between 100 -102 degree. So she was now put on Augmentin to which she responded. Though the patient was symptomatically better, the pelvic findings revealed the same mass which was still tender.
Diagnostic hysteroscopy and Laparoscopy was performed on 16.3.11.
A 5 x 6cm rt. ovarian abscess densely adherent to the right tube and the gut behind. The pus collection was drained and sent for cultures, whereas the abscess wall was removed and sent for examination. The anatomy was restored to as near normal as possible. The left tube and ovary were normal. Fleshy endometrial curettings were sent for further evaluation. Patient was put on broad spectrum injectable antibiotics.
A provisional diagnosis of (a) endometriosis and (b) ovarian abscess was made preoperatively.
Fever associated with endometriosis is usually low grade and not high grade as in “X”.
PID / TO abscess is one of the most serious complications of sexually transmitted diseases. It is an infection of upper genital tract infection that encompasses endometritis, salpingitis, salpingo-oophoritis and tubo- ovarian abscess and pelvic peritonitis.
Prompt diagnosis and treatment of this condition are critical because complications of PID can be life and fertility threatening. Laparoscopy is the gold standard to diagnose AND treat in such cases now.
With more and more indiscriminate use of postcoital contraception and over the counter easily available abortion pills we are getting to see more cases of PID leading to abscesses. This needs to be regulated in order to prevent long term consequences of morbidity.
Annually 1 million females develop PID and 1 in 8 sexually active adolescent girls develop PID before the age of20 years. Most common organisms attributed to causePID are Chlamydia trachomatis and Neisseria gonorrhoea. Other rare causes includeactinomycosis, tuberculosis and xanthomatous granulomas.
Patients with such a clinical entity do well with a minimal invasive procedure like diagnostic and operative laparoscopy with removal of the nidus of infection and good cover of postoperative antibiotics, thus giving a better chance of fertility with conservative surgical approach, rather than a more extensive procedure which sacrifices the tube and ovary.