Posthysterectomy pelvic abscess
- David E Soper, MD
David E Soper, MD
- Professor and Director of Specialists in Obstetrics and Gynecology
- Medical University of South Carolina
- Oluwatosin Jaiyeoba, MD, MSCR
Oluwatosin Jaiyeoba, MD, MSCR
- Assistant Professor of Surgery
- Obstetrics, Gynecology and Women’s Health Institute
- Cleveland Clinic
Pelvic abscess occurs as an infectious complication of surgery (eg, hysterectomy, cesarean delivery, induced abortion) or the result of infectious processes (eg, pelvic inflammatory disease, inflammatory bowel disease, diverticulitis). This topic will review the diagnosis and management of pelvic abscess complicating hysterectomy.
Less than 1 percent of patients undergoing obstetric or gynecologic surgery develop an abscess . In a retrospective cohort study of 23,366 patients undergoing either laparoscopic or abdominal hysterectomy, 783 (3 percent) developed a surgical site infection . Most of these were wound infections, but approximately one-quarter were infections of the organ space (or 0.7 percent of the entire cohort [210/23,366]).
Risk factors for posthysterectomy pelvic abscess can be separated into pre-, intra-, and postoperative elements. Risk reduction is focused on eliminating as many factors as possible. We counsel women with multiple nonmodifiable risk factors about their increased risk for postoperative abscess and possible need for subsequent treatment.
●Preoperative risk factors for posthysterectomy abscess include untreated pelvic inflammatory disease (PID), bacterial vaginosis, endometrioma, hydrosalpinx, prior laparotomy, anatomic anomalies, nonwhite race, renal comorbidities, and American Society of Anesthesiologists class ≥3 [1-5]. Bacterial vaginosis at surgery increases the risk of both posthysterectomy cuff cellulitis [6,7] and subsequent pelvic abscess formation . (see "Bacterial vaginosis", section on 'Gynecologic procedures' and "Overview of anesthesia and anesthetic choices", section on 'Preoperative risk assessment').
●Intraoperative risk factors include perioperative blood transfusion and operative time >180 minutes for laparoscopic hysterectomy . In addition, one retrospective review of 413 women undergoing hysterectomy at a single institution reported increased risk of postoperative pelvic abscess when gelatin-thrombin matrix was used during surgery .
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- RISK FACTORS
- PATIENT PRESENTATION
- DIFFERENTIAL DIAGNOSIS
- DIAGNOSTIC EVALUATION
- Hemodynamically unstable patients
- Hemodynamically stable patients
- - Antibiotic therapy
- Antibiotic regimen
- Antibiotic treatment duration
- - Decision for percutaneous drainage
- Percutaneous drainage
- Treatment failure
- - Risk factors
- - Management approach
- - Surgical technique
- SUMMARY AND RECOMMENDATIONS