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A pelvic abscess is the end stage in the progression of a genital tract infection and is frequently preventable. The abscess may fill the pelvis and occasionally the lower abdomen, and is usually posterior to the uterus and bound by the sigmoid colon, loops of small bowel, cul-de-sac, and sidewalls of the pelvis. A tubo-ovarian abscess may occur in the acute stage of pelvic inflammatory disease (PID) but is more common with chronic or subacute PID. An abscess occurs when pus from the fallopian tube spills onto the ovary and infects it at the site of follicular rupture or by direct penetration. Pelvic and abdominal pain which is bilateral and aggravated by motion and intercourse, and fever possibly exceeding 103 degrees fahrenheit with leucocytosis, tachycardia, and prostration are the most common symptoms of pelvic abscess.Pelvic abscesses can occur after surgery or in patients with medical conditions such as Crohn's disease, diverticulitis, ischemic colitis, sexually transmitted diseases, or septic emboli from endocarditis. Pelvic abscesses causing extraluminal rectal compression have a fair to good prognosis depending on location. In singular large abscesses, drainage may be attempted per vagina assuming solid adhesions to the vagina exist, or via laparotomy. Appropriate systemic antibiotics should be administered after drainage. Penicillin at 22,000 U/kg once or twice daily is suitable when A. pyogenes is isolated from the abscesses. Organic iodide powder may be fed at 1 oz/day for 2 to 3 weeks for its nonspecific activity against thick-walled abscesses. If drainage is not possible without contamination of the peritoneal cavity, prognosis is poor, but long-term penicillin therapy (3 to 6 weeks) and oral iodide powder for a similar length of time may be tried. The addition of rifampin to the antibiotic regimen may also be considered to improve abscess penetration, although this represents extralabel drug use; absorption is variable; and the drug is quite expensive.Treatment of perimetritis is not highly successful but includes broad-spectrum intensive antibiotic therapy to control the mixed bacterial flora likely found in such cases. Analgesics such as flunixin meglumine also are indicated.I hope this was helpful.
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