Pyogenic pelvic thrombophlebitis

　　Pyogenic pelvic thrombophlebitis can occur after pelvic surgery infection, and a few cases occur in salpingo-ovarian abscesses, but it is most common in puerperal infection and abortion infection. The disease is mainly caused by anaerobic bacilli and anaerobic cocci infections, and the bacteria and their endotoxins directly activate factor VIII through damaged vascular endothelial cells, thereby initiating the coagulation system.

　　Pyogenic pelvic thrombophlebitis is a serious complication of pelvic infection. If pyogenic pelvic thrombophlebitis is not controlled in time, it can lead to sepsis and be fatal. Therefore, early detection and early treatment are necessary to avoid the progression of the disease.

　　The main manifestations of pyogenic pelvic thrombophlebitis are high fever, which can reach 40-41°C, presenting as remittent fever, with fluctuations in temperature, sometimes high and sometimes low, with great fluctuations, and frequent recurrence, often accompanied by chills. The patient's pulse is rapid and persistent, and most patients only feel mild lower abdominal pain. If there is severe pain and percussion pain in the right upper quadrant and costovertebral angle area, it should be considered that there is ovarian vein thrombophlebitis.

　　Pyogenic pelvic thrombophlebitis most commonly occurs in puerperal infection and abortion infection. Therefore, the disease is mainly preventive in nature, aiming to prevent infections such as postoperative pelvic infection, puerperal infection, and abortion infection.

　　The diagnosis of purulent pelvic thrombophlebitis mainly relies on auxiliary examinations, and the common clinical examinations include blood routine, blood culture, etc.
　　1. Blood routine and ESR examination:It proves the existence of inflammation.
　　2. Blood culture:Blood culture is often negative during high fever, occasionally with positive Streptococcus hemolyticus, Escherichia coli, but anaerobic bacterial culture can find anaerobic streptococcus and Bacteroides fragilis.
　　3. Drug susceptibility test:It provides a basis for the selection of antibiotics.
　　4. X-ray chest film:It may provide clues, and if there is pulmonary embolism or abscess, it will be helpful for diagnosis.
　　5. Doppler ultrasound blood flow image:The modified examination can understand whether the vein is unobstructed and whether there is thrombosis.

　　For patients with purulent pelvic thrombophlebitis, high-vitamin, high-protein, high-calorie, low-fat diet should be provided, and liquid or semi-liquid light diet should be provided for the patient. Patients are recommended to drink warm milk or listen to light music to relax the brain and promote sleep. Patients should avoid spicy, sweet, fatty foods to prevent increased blood viscosity and aggravation of the condition; any dairy products, fried foods, salted foods, and processed foods should be prohibited.

　　The treatment of purulent pelvic thrombophlebitis includes drug treatment and surgical treatment, and the specific treatment methods are as follows:

　　First, Drug Treatment
　　1. Experimental Treatment: After intravenous infusion of heparin for 36 hours, the body temperature drops and the condition improves.
　　2. Antimicrobial and Anticoagulant Therapy: Antimicrobial: After the application of high-efficiency, broad-spectrum antibiotics for 48 to 72 hours, if the fever does not subside and the signs of improvement are not obvious, anticoagulant therapy should be considered; Anticoagulant therapy: To achieve good efficacy, it must be carried out as soon as possible, and the dose must be sufficient, through preventing the continuation of coagulation, finally achieving the purpose of unblocking the clot.

　　Second, Surgical Treatment
　　Surgery is only suitable for patients with contraindications to anticoagulant therapy, continued expansion of septic thrombosis, or ineffective drug treatment. The scope of surgery includes ligation of the bilateral ovarian veins and the inferior vena cava. Since collateral circulation is established quickly after surgery, there are generally no adverse consequences after surgery, the edema of the dorsum of the foot can disappear within 6 weeks, and there is generally no effect on ovarian function.