Medicina

Reviews in Gynaecological and Perinatal Practice 6 (2006) 185–191 www.elsevier.com/locate/rigapp

Pelvic inflammatory disease and pelvic abscesses
Zeenat Eva Khan, Javed H. Rizvi *
Department of Obstetrics & Gynaecology, The Aga Khan University Hospital, Karachi, Pakistan Received 28 March 2006; accepted 1 June 2006 Available online 13 July 2006

Abstract Pelvic inflammatory disease andpelvic abscesses have been reported as a major complication following a wide variety of obstetrical, gynaecological and surgical procedures. The aim of this review article is to emphasize the need for a more aggressive approach to detect and to treat what can be a debilitating condition that if inadequately treated may result in mortality. The large numbers of options available are discussed under theheadings of: conservative management, interventional radiological management and surgical treatment. Lastly, preventive strategies are discussed, as pelvic inflammatory disease may result in tubal factor infertility, ectopic pregnancies, chronic pelvic pain and tubo-ovarian/pelvic abscesses. # 2006 Elsevier B.V. All rights reserved.
Keywords: Pelvic inflammatory disease; Pelvic abscess; Prevention;Diagnosis and management

1. Introduction Pelvic inflammatory disease (PID) is defined as an ascending infection of the upper genital tract leading to infection of the endometrium, fallopian tubes, ovaries and peritoneum. Tubo-ovarian abscesses (TOA) and pelvic abscesses are a relatively common complication of PID, occurring in approximately 30% of women who are hospitalized for the treatment ofPID [1]. The incidence of pelvic inflammatory disease increased in the 1970s and 1980s due to an increase in sexually transmitted diseases in developed countries. Recently, there has been a small decline in the number of new cases of PID (based on outpatient and inpatient discharges gathered from hospital data bases). The incidence figures provided by the Centre for Disease Control and Prevention(CDC) states that approximately 780,000 cases of acute PID are diagnosed annually which when compared to the one million cases in the 1970s and 1980s is a 22% reduction [2].

A more recent study from Norway on women admitted to hospital with a diagnosis of PID during the years 1990–1992 and 2000–2002 and found a 26% reduction in hospitalized cases of salpingitis [3]. In this article the number ofwomen treated for tubo-ovarian abscesses remained unchanged. During the two decades under review there was a significant reduction in sexually transmitted infections especially Chlamydia trachomatis, which is a success story of the screening program. In developing countries hospital admissions for PID in the reproductive age group may reach as high as 40%. In these under privileged countries pelvictuberculosis accounts for some tubo-ovarian abscesses through the exact incidence of genital tuberculosis is unknown. 1.1. Risk factors Known risk factors for pelvic inflammatory disease and hence tubo-ovarian abscess are: 1. 2. 3. 4. sexually transmitted infections (gonorrhea, chlamydia); young age (15–24 years); previous history of PID; multiple sexual partners;

* Correspondence to:Department of Obstetrics & Gynaecology, The Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan. Tel.: +92 214864641; fax: +92 214934294. E-mail address: javed.rizvi@aku.edu (J.H. Rizvi). 1871-2320/$ – see front matter # 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.rigapp.2006.06.001

186

Z.E. Khan, J.H. Rizvi / Reviews in Gynaecological and Perinatal Practice6 (2006) 185–191

5. bacterial vaginosis; 6. surgical instrumentation through the cervix including termination of pregnancy. Other factors may be demographic or are still unresolved risk factors for pelvic inflammatory disease. These risk factors are low socio-economic group, single or divorced, rape and coitus during menstruation. Substances abuse, smoking, vaginal douching and the use of an...