How inflammation develops
The pelvic peritoneum is a thin membrane covering the uterus, appendages and neighboring organs. It is very sensitive to infection and quickly reacts with inflammation, producing effusion. Most often, microbes enter it in an ascending way: from the vagina and cervix into the uterine cavity, then into the tubes and through their ends into the abdominal cavity. The second option is direct infection when a purulent formation of the appendages ruptures or after surgery. In response, the peritoneum sticks together, limiting the focus, and it is these adhesions that later become adhesions.
- Ascending infection from the vagina and uterus
- Complication of salpingoophoritis
- Rupture of purulent formation of appendages
- Postpartum and post-abortion complications
- Complications of intrauterine interventions
- Transition of inflammation from the appendix or intestine
Risk factors
The risk is higher in women with sexually transmitted infections, especially chlamydial and gonococcal infections, which are often hidden. Any interventions that open the way for microbes into the uterine cavity are significant: abortion, curettage, hysteroscopy, insertion of an intrauterine device, as well as childbirth, especially complicated ones. Frequent changes of partners without barrier contraception, untreated chronic inflammatory diseases of the appendages, decreased immunity, diabetes mellitus and hypothermia as a provoking factor contribute to the development of inflammation.
- Chlamydial and gonococcal infection
- Chronic salpingoophoritis
- Abortion and intrauterine interventions
- Complicated childbirth and postpartum endometritis
- Intrauterine device
- Lack of barrier contraception
- Reduced immunity and diabetes
Symptoms
The onset is usually acute: pain in the lower abdomen quickly increases, becomes constant, intensifies with movement, coughing and trying to stand up. The temperature rises to 38–39 degrees, chills, weakness appear, and the pulse quickens. The abdomen is swollen, the muscles are tense, the touch is painful, and the pain intensifies when the hand is quickly removed. There is often nausea and vomiting, retention of stool and gas, and painful urination. Purulent leucorrhoea may be discharged from the genital tract. When examined by a gynecologist, the vaginal vault and displacement of the cervix are sharply painful.
- Sharp, constant pain in the lower abdomen
- Temperature with chills
- Muscle tension in the anterior abdominal wall
- Nausea, vomiting, bloating
- Retention of stool and gas
- Purulent discharge from the genital tract
- Increased heart rate, weakness, sweating
Survey
The diagnosis is made urgently, combining examination and a minimum set of studies. High leukocytosis with a shift in formula, accelerated ESR, and elevated C-reactive protein are visible in the blood. A pelvic ultrasound shows free fluid in the retrouterine space, enlarged tubes and ovaries, and purulent formations. They take smears and cultures from the cervical canal and be sure to rule out pregnancy. Puncture of the posterior vaginal fornix allows you to obtain the contents and understand its nature. In doubtful cases, the best method is diagnostic laparoscopy, which immediately turns into therapeutic laparoscopy.
- Examination by a gynecologist with assessment of the vaginal vaults
- Complete blood count, C-reactive protein
- Ultrasound of the uterus and ovaries, search for free fluid
- Smear and culture from the cervical canal
- Pregnancy test to exclude ectopic
- Puncture of the posterior vaginal fornix
- Diagnostic laparoscopy
- General urine test and consultation with a surgeon
Treatment
Treatment is carried out only in a hospital. A combination of broad-spectrum antibiotics is prescribed intravenously, taking into account the likely pathogens, including chlamydia and anaerobes, and infusion therapy, anesthesia and rest are added. If there is a purulent focus, free pus in the pelvis, or no improvement within a day or two, laparoscopy is performed: the pus is removed, the cavity is washed, if necessary, drainage is installed and destroyed tissue is removed. The second part of treatment is also important - examination and treatment of the sexual partner, otherwise the inflammation returns.
- Mandatory hospitalization
- Broad-spectrum intravenous antibiotics
- Infusion and analgesic therapy
- Laparoscopy with sanitation and drainage of the pelvis
- Removal of purulent formations of the appendages if necessary
- Removal of the intrauterine device if it is the cause
- Examination and treatment of sexual partner
- Rehabilitation and prevention of adhesions after recovery
