1/53. Sonographically guided intralesional antibiotic injection for treatment of a recalcitrant pelvic abscess: a case report.A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
2/53. Pelvic actinomycosis. Is long-term antibiotic therapy necessary?OBJECTIVE: To describe 11 cases of actinomycosis and analyze whether long-term antibiotic use in necessary. STUDY DESIGN: Analysis of 11 cases of pelvic actinomycosis diagnosed and treated during the last nine years. Four patients had an intrauterine device (IUD) for 6-20 years, three patients had an IUD for 3-5 years, and four patients had no known etiology. In most patients the symptoms lasted from several days to one month. The actinomycotic lesions involved one or both ovaries in all 11 cases. In five patients the lesion extended to other areas, such as the uterus, omentum, parametrium, pelvic walls, colon, bladder, cul-de-sac and gallbladder. RESULTS: All patients underwent surgery that included removal of the lesions with the ipsilateral or both adnexa and, in specific cases, with extension of the lesions, hysterectomy, omentectomy, hemicolectomy and cholecystectomy. Confirmation of the diagnosis of actinomycosis was done by histology in all cases, and antibiotic treatment usually began 1-14 days after surgery. The drug of choice was penicillin. The duration of treatment was 12 months in 6 patients, 6 months in 3 and < or = 3 months in two. All patients were alive and well after two to nine years of follow-up. CONCLUSION: In contrast to actinomycosis at other sites, where the literature recommends antibiotic therapy for 6-12 months, pelvic actinomycosis could be a limited disease. We propose that in cases of pelvic actinomycosis where the abscess can be completely removed surgically, a shorter period of antibiotic therapy can be effective.- - - - - - - - - - ranking = 0.11111111111111keywords = abscess (Clic here for more details about this article) |
3/53. Large bowel obstruction due to intrauterine device: associated pelvic inflammatory disease.Pelvic actinomycosis associated with the use of intrauterine contraceptive devices (IUDs) can mimic pelvic malignancy. Recognizing this rare, but not uncommon complication of IUD use can spare a patient from an extensive surgical procedure. If recognized preoperatively, a simple regimen of antibiotics can be curative; however, if symptomatic, a limited surgical procedure is warranted. We present the case of a 55-year-old woman with a slow, indolent course of partial large bowel obstruction and a history of IUD use for over 20 years. A preoperative CT scan revealed a frozen pelvis mimicking a pelvic malignancy. Exploratory laparotomy revealed a firm, indurated, fibrotic reaction in the pelvis involving the uterus, adnexa, and sigmoid colon. A diverting loop colostomy was performed, and pathology revealed sulfur granules from the extracted IUD that grew actinomyces. The patient was treated with the appropriate antibiotics, and during the takedown of the colostomy 6 months later the pelvic inflammation was completely resolved. An extensive review of the literature involving actinomycotic abscesses associated with IUD use reveals a limited number of studies reported in the general surgical literature. It behooves the general surgeon to be aware of this unusual case so that the appropriate consultation and treatment can be performed with limited morbidity to the patient.- - - - - - - - - - ranking = 0.11111111111111keywords = abscess (Clic here for more details about this article) |
4/53. magnetic resonance imaging of actinomycosis presenting as pelvic malignancy.Pelvic actinomycosis is associated with long-standing use of an intrauterine contraceptive device and may present with clinical signs and symptoms of pelvic malignancy. diagnostic imaging can confirm the presence of a pelvic mass and tissue infiltration but findings are often non-specific. We present a case of pelvic actinomycosis with tubo-ovarian abscess in which magnetic resonance imaging demonstrated lower signal intensity tissue on T2 weighted sequences than would be typical for pelvic malignancy or infection and was useful in confirming regression of pelvic disease in response to antibiotic therapy.- - - - - - - - - - ranking = 0.11111111111111keywords = abscess (Clic here for more details about this article) |
5/53. Pelvic abscess from enterobius vermicularis. Report of a case with cytologic detection of eggs and worms.BACKGROUND: enterobius vermicularis is known to produce perianal and ischioanal abscesses and invade the peritoneal cavity via the female reproductive system, causing pelvic peritonitis. However, there are only rare case reports on the cytodiagnosis of these parasitic lesions. CASE: A 28-year-old woman was admitted with a tender left iliac fossa mass and greenish vaginal discharge. Ultrasonogram and computed tomography scan confirmed the presence of a mass lesion suggestive of a tuboovarian abscess. Cytologic examination of the pus obtained during left salpingo-oophorectomy revealed the presence of ova of E vermicularis and fragments of the adult worm in an inflammatory exudate consisting predominantly of neutrophils, eosinophils and occasional epithelioid cell granulomas. paraffin sections of the tuboovarian mass showed necrotizing epithelioid cell granulomas, but neither ova nor any worm section was identified. Although the possibility of tuberculosis was considered histologically, Ziehl-Neelsen (Z-N) stain for acid-fast bacilli was negative. Z-N staining of the smear and mycobacterial culture of the pus also did not yield positive results. CONCLUSION: E vermicularis may cause tuboovarian abscess with necrotizing epithelioid granulomas mimicking tuberculosis. Cytologic examination of the pus is helpful in the diagnosis.- - - - - - - - - - ranking = 0.77777777777778keywords = abscess (Clic here for more details about this article) |
6/53. Tubo-ovarian abscess presenting as pneumoperitoneum.BACKGROUND: Tubo-ovarian abscess (TOA), a serious complication of pelvic inflammatory disease, often require the antibiotic administration, surgical resection or the transvaginal aspiration. pneumoperitoneum is often associated with the bowel perforation. We reported one case with TOA and pneumoperitoneum that have been mistaken for a perforated bowel with concomitant adnexal mass. CASE: A 30-year-old diabetic Chinese woman was transferred for diffused abdominal pain, mild fever, nausea, and low-grade fever for 5 days. The sonography revealed a 5-cm adnexal mass. The chest x-rays revealed the pneumoperitoneum. Under the impression of bowel perforation and concomitant adnexal cyst, the emergent laparotomy was performed and the TOA was resected. No evidence of gastrointestinal perforation was present. culture studies showed escherichia coli without other bacteria flora. The postoperative course was uneventful. CONCLUSION: We concluded that, beside the bowel perforation, TOA should be considered when a diabetic woman presents with pneumoperitoneum and adnexal mass.- - - - - - - - - - ranking = 0.55555555555556keywords = abscess (Clic here for more details about this article) |
7/53. Ureteric obstruction caused by pelvic actinomycosis.Ureteric obstruction is a well-known complication of actinomycosis, however its management in previous case reports has been very variable and sometimes mutilating. We report a rare case presenting with ischiorectal abscess that was successfully treated by JJ stenting and penicillin.- - - - - - - - - - ranking = 0.11111111111111keywords = abscess (Clic here for more details about this article) |
8/53. Small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease.BACKGROUND: Small cell carcinoma of the endometrium is a rare disease entity characterized by bulkiness and predisposition to necrosis. Clinical presentations include postmenopausal bleeding, lower abdominal mass, chronic abdominal pain and menorrhagia. We present a case of small cell carcinoma of the endometrium with concomitant pelvic inflammatory disease. The literature is also reviewed. CASE: A 64 year old female presented was admitted with the principal complaints of fever, lower abdominal pain and malodorous vaginal discharge. Bimanual examination revealed cervical motion tenderness with a WBC of 9400 cells/microL and increased levels of neutrophils, band cells and c-reactive protein. Sonography revealed an adnexal echocomplex compatible with tubo-ovarian abscess. culture of the vaginal discharge revealed the presence of E. coli. Symptoms persisted despite three days of antibiotics administration so a laparotomy was performed with a friable hemorrhagic uterus revealed and an area of necrosis evident in the left adnexa. Malignancy was confirmed from frozen section. Total abdominal hysterectomy, with bilateral salpingooophorectomy and optimal debulking, was performed. The final pathology report confirmed small cell carcinoma of the endometrium. CONCLUSION: Malignancy and pelvic inflammatory disease have overlapping clinical characteristics. Once pelvic inflammatory disease is suspected in a postmenopausal patient, malignancy should also be suspected, and a thorough examination and a tumor-marker analysis performed.- - - - - - - - - - ranking = 0.11111111111111keywords = abscess (Clic here for more details about this article) |
9/53. pseudomonas aeruginosa-infected IUD associated with pelvic inflammatory disease. A case report.BACKGROUND: While pelvic infection is known to be an infrequent complication of intrauterine device (IUD) use, infections are usually related to microorganisms introduced at the time of insertion or by sexual contact. CASE: We diagnosed a 35-year-old woman with an IUD for 6 years with pelvic inflammatory disease (PID) and implemented antibiotic therapy. Her clinical course worsened, and exploratory surgery revealed a right tuboovarian abscess with multiple loculated pelvic abscesses. culture of the IUD found heavy growth of pseudomonas aeruginosa. CONCLUSION: P aeruginosa has not previously been described in association with infections of the upper female genital tract. Double coverage with appropriate antipseudomonal agents is essential for proper treatment of pseudomonal infections.- - - - - - - - - - ranking = 0.22222222222222keywords = abscess (Clic here for more details about this article) |
10/53. Incidental tubo-ovarian abscess at abdominal delivery: a case report.Tubo-ovarian abscess in the third trimester of pregnancy is extremely rare. In this report, an unusual case with asymptomatic tubo-ovarian abscess, diagnosed incidentally during cesarean section performed for an obstetric indication, is presented. Unlike other reported cases, no signs or symptoms attributable to pelvic abscess throughout the pregnancy were observed in our patient. To our knowledge, this is the first report of such a case in the literature.- - - - - - - - - - ranking = 0.77777777777778keywords = abscess (Clic here for more details about this article) |
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