Pelvic abscess

It is used in the treatment of severe anaerobic infections caused by bacteroides and other anaerobes. It is also used in combination with aminoglycoside in the treatment of abdomen and GIT wounds, infections of female genital tract, pelvic abscesses, aspiration pneumonia and septic abortion. It is also used for prophylaxis of endocarditis. It is also used along with primaquine in Pneumocystis carinii pneumonia in AIDS patients and with pyrimethamine for toxoplasmosis. 

Clindamycin is indicated for the treatment of skin and soft-tissue infections caused by streptococci and staphylococci. It is often active against community-acquired strains of methicillin-resistant S aureus, an increasingly common cause of skin and soft tissue infections. Clindamycin is also indicated for treatment of anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses and aspiration pneumonia. Clindamycin is now recommended rather than erythromycin for prophylaxis of endocarditis in patients with valvular heart disease who are undergoing certain dental procedures. Clindamycin plus primaquine is an effective alternative to trimethoprim-sulfamethoxazole for moderate to moderately severe Pneumocystis jiroveci pneumonia in AIDS patients. It is also used in combination with pyrimethamine for AIDS-related toxoplasmosis of the brain. 

Clindamycin is indicated for treatment of severe anaerobic infection caused by bacteroides and other anaerobes that often participate in mixed infections. Clindamycin, sometimes in combination with an aminoglycoside or cephalosporin, is used to treat penetrating wounds of the abdomen and the gut infections originating in the female genital tract, eg, septic abortion and pelvic abscesses or... 

Choo YC, Cho KJ (1980) Pelvic abscess complicating embolic therapy for control of bleeding cervical carcinoma and simultaneous radiation therapy. Obstet Gynecol 55[Suppl] 76S-78S... 

Harisinghani MG et al. (2003) Transgluteal approach for percutaneous drainage of deep pelvic abscesses 154 cases. Radiology 228 701-705... 

Anaerobes Serious respiratory tract infections such as empyema, anaerobic pneumonitis, and lung abscess serious skin and soft tissue infections septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal Gl tract) infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. 

Treatment of sepsis to which anaerobic organisms, e.g. Bacteroides spp. and anaerobic cocci, are contributing, notably postsurgical infection, intra-abdominal infection and septicaemia, but also woimd and pelvic infection, osteomyelitis and abscesses of brain or lung... 

Metronidazole has been shown to be of great value in the management of anaerobic bacterial infections [20,27,75,76]. The role of this drug in the prophylaxis and treatment of various anaerobic bacterial infections, which may develop following appendectomy, elective colonic surgery, colo-rectal surgery and hysterectomy [20,77,78]. Mebendazole is equally useful in cases of endocarditis, osteomyelitis, lung abscess, empyema, peritonitis, septicemia and pelvic infections [79]. 

The causes of intraabdominal abscess overlap those of peritonitis and, in fact, may occur sequentially or simultaneously. Appendicitis is the most frequent cause of abscess. Other potential causes of intraabdominal abscess include pancreatitis, diverticulitis, lesions of the biliary tract, genitourinary tract infections, perforating tumors in the abdomen, trauma, and leaking intestinal anastomoses. In addition, pelvic inflammatory disease in women may lead to tuboovarian abscess. For certain diseases, such as appendicitis and diverticulitis, abscesses occur more frequently than generalized peritonitis. 

Fig. 1.65a-c. CT in appendicitis. A 13-year-old girl treated with antibiotics for pelvic pain and fever, a US shows a non-specific cystic mass (M) cranial to the uterus (U). No flow was observed on color Doppler study. b,c CT clearly demonstrates the close relationship between the mass (A) and the enlarged appendix (arrow) with an appendicolith (arrowhead). An appendiceal abscess was demonstrated at surgery. B, Bladder A, abscess... 

In the majority of cases, tuboovarian abscesses (TOA) result from pelvic inflammatory disease. It is reported to complicate PID in up to one-third of patients hospitalized for treatment [6]. Other etiologies include complications of surgery or intra-abdominal inflammatory bowel diseases, such as appendicitis, diverticulitis, or Crohn disease. In most cases, TOA is caused by a polymicrobial infection with a high prevalence of anaerobes. lUD users, especially in the first few months after insertion, are also under a higher risk of PID. Pelvic actinomycosis is considered to be highly associated with the use of lUD [1]. 

TOA most commonly occurs in women in the reproductive ages. Tuboovarian abscesses in postmenopausal women are rare, and encountered in patients with diabetes or previous radiation therapy [7]. Because of the significant association with malignancies in postmenopausal women presenting with TOAs, a concomitant pelvic malignancy should be excluded [8]. 

Fig. 17.5a,b. Peritonitis in tuboovarian abscess. Transaxial CT sans in the mid pelvis (a, b). A left-sided tuboovarian abscess is located adjacent to the pelvic sidewall (arrow) between internal and external iliac vessels (a). It presents as a cystic peripherally enhancing lesion with a fluid-fluid level (arrowhead) presenting debris (a). Associated flndings include ascites, linear peritoneal enhancement (small arrows), and a netlike involvement of the pelvic fat and the omentum (arrow) (b)... 

Fig. 17.6a-c. Abscess involving ovaries and sigmoid colon. Three consecutive CT scans (a-c) in and above the acetabular level in a 36-year-old woman with pelvic pain and leukocytosis. A multiseptate cystic lesion (arrow) with perilesional fat stranding is identified lateral of the uterus (a, b) involving the left adnexa and sigmoid colon. The tiny spot of free air (small arrow) is highly specific of the inflammatory nature of this process (b)... 

Clinically, ruptured ovarian cysts may resemble ovarian torsion. In a patient with acute pelvic pain, a hemorrhagic lesion within a normal size ovary is typically a ruptured ovarian cyst. Furthermore, unlike in most cases of ovarian torsion, clotted blood may be detected in the lesser pelvis. Wall edema of an adnexal mass, engorged adnexal vessels or dilatation of the fallopian tube are missing. TUboovarian abscess and hydrosalpinx may resemble advanced adnexal torsion. Lack of enhancement supports the diagnosis of ovarian torsion. In children, sonography usually allows the diagnosis of appendicitis as a cause of acute pelvic pain. In case of a suspected abscess or an ovarian mass, MRI may aid in further assessment of the adnexa. Rarely, a calcified mass may result from chronic infarction which cannot reliably be differentiated from a calcified ovarian tumor [19]. 

A patient with an acute abdomen should not he inflated with room air or CO2, and a consultation with a surgeon is most appropriate. Patients with active diverticulitis should not he referred to CT colonography. If an abscess or free air is suspected, a CT of the abdomen and pelvis can be performed with oral and IV contrast. Insufflation of the colon is contraindicated and may cause perforation and widespread peritonitis. Similarly, if a patient has recently undergone pelvic or abdominal surgery. 

Depending on the location of a pelvic fluid collection, different access paths determined by the surrounding pelvic ring are suitable the presacral approach (patient in prone position) is especially useful in patients who develop a presacral abscess after an abdominoperineal resection (Fig. 37.13). Using a sUght (double) angula-... 

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