Management of pelvic abscess—challenges for a gynecologist

Abstract

Objectives: To analyze the difficulties in diagnosis, treatment, and postoperative care in patients with pelvic abscess. Study design: This is an observational study; 11 patients underwent laparotomy for drainage of pelvic abscess between January 1, 2015, and December 31, 2018. The diagnosis of pelvic abscess was a spot diagnosis only in one patient. It was a surprise finding, on table, in three patients. The most common confounding diagnosis was ovarian torsion. Two patients had subacute intestinal obstruction like clinical features. Results: All patients improved following laparotomy and drainage of pus. In the first six patients in our series, the skin was closed immediately following closure of the rectus sheath, and all of them developed wound dehiscence. In the last five patients in our series, delayed primary closure was performed. The skin was closed after wound turned healthy and comorbid conditions controlled and corrected. All five patients had a healthy scar. The shortest duration of hospital stay was 18 days, and the longest duration of hospital stay was 55 days. Conclusion: Pelvic abscess is one condition which can test the clinical acumen of a gynecologist to make a prompt and correct diagnosis and to manage multiple postoperative problems like uncontrolled diabetes, sepsis, and a wound which will require daily dressing for several days. This is one of the few gynecological conditions where a delayed primary closure should be performed. And most importantly, the gynecologist has to manage spiraling treatment costs and a falling patient morale.