Pelvic abscess

　　The pathogens causing pelvic abscesses are mostly aerobic bacteria, anaerobic bacteria, gonococci, chlamydia, mycoplasma, etc., with anaerobic bacteria being the main pathogens. The most commonly found in abscess fluid culture are Bacteroides fragilis and Escherichia coli of the Bacteroides genus. In recent years, Actinomycetes (especially the genus Actinomyces israelii) have been found to be common pathogens causing pelvic abscesses, and are related to the placement of intrauterine contraceptives. This pathogen is difficult to culture, so the failure to culture the pathogen using general methods does not mean that the pathogen does not exist. Pelvic abscesses often occur due to delayed treatment or recurrent attacks of acute salpingitis, or after the use of intrauterine contraceptives, etc.

　　If the treatment of pelvic abscesses is not timely or the condition is severe, serious diseases may occur, such as infectious shock and painful shock, which often threaten life, so this disease should not be overlooked.

　　Patients with pelvic abscesses may have manifestations of acute adnexitis and abscesses.

　　1. Manifestations of acute adnexitis

　　After the formation of abscesses, there is often high fever, with the patient's body temperature reaching about 39℃. Heart rate increases and lower abdominal pain occur, with acute abdominal pain accounting for 89%, chronic pain for 19%, and at the same time, an increase in vaginal discharge and abnormal uterine bleeding. Pelvic examination shows significant lower abdominal tenderness and cervical pain, and the uterus and bilateral adnexal areas are also extremely tender. Due to tenderness and resistance to palpation, bimanual examination is often unsatisfactory. Sometimes, a palpable mass can be felt on one side of the uterus, or a mass can be felt at the upper end of the uterorectal septum. Some patients may have a mild onset, with a slower formation process of abscesses and unclear symptoms, even without fever.

　　2. Manifestations of abscess

　　The symptoms of abscesses continue to worsen, with persistent remittent fever, more obvious peritoneal irritation signs, and symptoms such as rectal compression, defecation sensation, and urinary pain, which are irritative symptoms of the rectum and bladder. There are also systemic toxic symptoms. Bimanual examination and rectal examination feel that the pelvic cavity is full, the rectouterine陷凹tissue is thickened and hardened, or there is a fluctuant mass, with significant tenderness.

　　3, Symptoms of abscess rupture

　　After the appearance of a large amount of purulent stool, pus urine, or a large amount of pus discharged through the vagina, the clinical signs such as high fever, abdominal pain, and abdominal tenderness improve significantly. The examination shows that the existing mass has disappeared or decreased, indicating that the pelvic abscess has ruptured into the rectum, bladder, or vagina.

　　4, Symptoms of abscess rupture into the abdomen

　　If the condition suddenly worsens or the lower abdominal pain persists and becomes diffuse pain, accompanied by nausea, vomiting, chills, followed by a weak and rapid pulse, a sharp drop in blood pressure, and profuse cold sweat, physical examination shows the disappearance of abdominal breathing, diffuse abdominal tenderness, rebound tenderness, and marked muscle tension, and there is abdominal distension, decreased or absent bowel sounds. It indicates that the localized pelvic abscess has ruptured into the abdominal cavity and must be treated urgently.

　　Pelvic abscesses are mainly formed by the accumulation of pus after peritonitis or pelvic infection, and are a complication of peritonitis. Therefore, the key to preventing this disease is to actively treat peritonitis and enhance resistance. In addition, women should strengthen their physical exercise, enhance their physique, and improve their own ability to resist diseases in their daily lives. Take frequent showers and pay attention to keeping the vulva clean, avoiding unclean or uncontrolled sexual intercourse. If acute pelvic inflammatory disease occurs, it should be treated promptly and effectively to prevent its development into a pelvic abscess. Women with pelvic abscess should be hospitalized for treatment promptly. During the hospital stay, they should rest quietly, take a semi-recumbent position, and keep the abscess localized in the lower abdomen. They should eat high-nutrition and easy-to-digest food.

　　Patients with pelvic abscess should undergo blood tests, imaging examinations, and digital rectal examinations, etc.

　　One, Laboratory examination

　　1, White blood cells can increase or remain normal.

　　2, The erythrocyte sedimentation rate is often accelerated >40mm/h.

　　3, The serum C-reactive protein level is increased >16mg/L.

　　Two, Other examinations

　　1, B-ultrasound:It appears as a circular or patchy anechoic area within the pelvis, most of which have unclear boundaries. There are punctate, spotted, and strip-like moderate or low echo areas. After emptying the urine, a liquid level can be detected..

　　2, X-ray examination:In the erect abdominal flat film, pelvic abscesses, in addition to the fluid level within the abscess cavity and reflexive intestinal stasis, intestinal adhesion, and blurred or disappeared pelvic wall fat lines as generally seen in abdominal abscesses, are characterized by the fact that the anterior rectum to the sacrum is not aerated in the lateral view. If there is gas, the distance between the rectum and sacrum exceeds 15mm, or there are signs of compression around it. Barium meal or barium enema shows that the cecum and sigmoid colon are contracted, with edema signs, and the contrast agent passes quickly, with thickening of local folds. In the long run, it can also form a rectum, bladder, or vaginal fistula..

　　3, CT scan: Pelvic abscesses often occur around the rectum, in the pelvic lateral recess and the uterine rectal recess. Depending on the primary focus, the abscess can be located on one side, with thickened and roughened abscess walls. If liquefaction occurs, the center is of low density. Enhanced scan shows ring enhancement, with no enhancement in the central liquefaction area. If there is gas within the abscess, it is a reliable basis for diagnosis.

　　Three, Diagnostic puncture

　　Married women can perform a puncture through the posterior fornix of the vagina, while men can puncture through the rectum, and pus can be aspirated to confirm the diagnosis.

　　Four, Digital rectal examination

　　Digital rectal examination can reveal relaxed anal sphincter muscles, a distended rectum anteriorly with tender soft lumps.

　　Patients with pelvic abscess should not eat spicy food and drinks such as chili, Mahsuan, raw scallion, raw garlic, and white wine in daily life. Then, what kind of food is good for patients with pelvic abscess?

　　1, Patients can eat more foods such as lean meat, chicken, cabbage, asparagus, celery, eggs, crucian carp, turtle, spinach, tofu, kelp, cucumber, winter melon, mushrooms, nori, and fruits.

　　2, The diet of pelvic inflammatory disease patients should be mainly light and easy-to-digest food. Such as red beans, mung beans, winter melon, green beans, Job's tears, and Purslane. Food with the effect of promoting blood circulation, Qi regulation, and mass dissolution should be eaten, such as peach kernels, dried loquat peel, tangerine kernel, tangerine peel, hawthorn, rose, and tangerine. Appropriate protein should be supplemented, such as lean pork, duck, goose, and quail.

　　3, Patients should pay attention to dietary care and nutrition. During the fever period, light and easy-to-digest food should be eaten, and for patients with pelvic inflammatory disease who have high fever and injury to the body fluid, pear juice or apple juice, watermelon juice, etc. can be given for drinking, but not after being chilled.

　　For patients with cold stagnation of Qi, such as cold pain in the lower abdomen, fear of cold, and sore waist, warm foods such as ginger soup, brown sugar water, and Osmanthus meat can be given in diet. Those with restlessness of the five interiors, and sore waist, mostly belong to kidney Yin deficiency, and can eat blood-rich foods such as meat and eggs to nourish and strengthen the body.

　　Traditional Chinese medicine prescriptions are mainly for conservative treatment of pelvic abscess. Traditional Chinese medicine divides pelvic abscess into two types: heat-toxin obstruction type and dampness and turbidity obstruction type, and uses different herbs for each type:

　　1, Heat-toxin obstruction type

　　Treatment is aimed at clearing heat and detoxifying, dissolving blood stasis and reducing swelling. The prescription is 3 grams of Chuan mountain shell, 3 grams of Zaojiao, 3 grams of Dangguiwei, 3 grams of Gancao, 9 grams of Lianhua, 3 grams of Chishao, 3 grams of Moshi, 3 grams of Maima, 3 grams of Tianhuafen, 9 grams of Chenpi, 3 grams of Fangfeng, 3 grams of Beimu, 3 grams of Baizhi. If leukorrhea is abundant, yellow and smelly, add 10 grams of Huangbai and 30 grams of Yiyiren to clear heat and dampness.

　　2, Dampness and turbidity obstruction type

　　Treatment is aimed at promoting diuresis and Qi, activating blood circulation and dissipating masses. The formula is modified and added to Tuoli Disinfection Powder. The prescription is 15 grams of Dangshen, 15 grams of raw Huangqi, 10 grams of Gancao, 10 grams of Baizhu, 15 grams of Fuling, 10 grams of Danggui, 12 grams of Chishao, 25 grams of Lianhua, 10 grams of Baizhi, 10 grams of Jiegeng, 10 grams of Zaojiao. If there is a slight fever, add 15 grams of Huxingcao and 10 grams of Gongying to clear heat and detoxify.