The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.
Abscess ; Animals ; Anti-Bacterial Agents ; Appendicitis ; Diagnosis, Differential ; Endometritis ; Endometrium ; Female ; Gastroenteritis ; Genitalia ; Ovary ; Parametritis ; Pelvic Inflammatory Disease ; Peritoneum ; Pregnancy ; Pregnancy, Ectopic ; Salpingitis ; Vagina

The pelvic inflammatory disease (PID) occurs when microbacteria ascend via vagina to the upper genital organs such as endometrium, tubes, ovaries and even pelvic peritoneum as a result of infected intercourse. That could be presented as perihepatitis, parametritis, intraperitoneal pelvic inflammatory disease, not to mention endometritis, salpingitis and tubo-ovarian abscess. Symptoms and signs of PID resembles those of several abdominal diseases such as acute appendicitis, acute gastroenteritis, ectopic pregnancy, and adnexal torsion. Especially differentiation of acute appendicitis from PID is very important because acute appendicitis must be treated by operation but PID could be treated by surgery or antibiotics only even though their symptoms and signs are very alike. So, diagnostic pelviscopy for PID is very important for differential diagnosis and further management. We experienced and report four cases of appendicitis that could not be diagnosed differentially from PID which managed with the emergent pelviscopy successfully.
Abscess ; Animals ; Anti-Bacterial Agents ; Appendicitis ; Diagnosis, Differential ; Endometritis ; Endometrium ; Female ; Gastroenteritis ; Genitalia ; Ovary ; Parametritis ; Pelvic Inflammatory Disease ; Peritoneum ; Pregnancy ; Pregnancy, Ectopic ; Salpingitis ; Vagina

OBJECTIVE: This study aimed to identify the predictors for treatment failure of medical management among admitted female patients diagnosed with pelvic inflammatory disease with tubo-ovarian abscess. METHODS: This was a retrospective nested case-control study, using chart review of all cases of pelvic inflammatory disease with tubo-ovarian abscess/complex (N = 49) admitted at the Department of Obstetrics and Gynecology, Philippine General Hospital from January 1, 2014 to December 31, 2018. RESULTS: Medical treatment failure was observed to be significantly higher (51.9%) among patients 40 years old and above as compared to patients less than 40 years old (13.6%). The risk of patients ≥40 years for failed management was 14x higher than those <40 years old (OR=14.00; 95% CI=1.06 to 185.5;p=0.04). The failed management group has significantly higher TOA size of 7.8 (7.8 ± 1.6) as compared to only 5.8 (5.8 ± 1.4) for medical treatment alone group. Correspondingly, those who failed have a significantly bigger volume of 120.4 ml (120.4 ± 84.5) as compared to only 55.2 ml (55.2 ± 40.6) for medical treatment alone group. Other predictive factors such as parity, admitting White blood cell count(WBC), C-Reactive Protein (CRP), and neutrophil-lymphocytic ratio(NLR) were all not significant. CONCLUSION: Tubo-ovarian abscess size of more than or equal to 7 cm, or a volume of more than or equal to 120 ml and advanced age of >40 were all predictive of failed response to medical treatment. Early recognition and intervention whether surgery or drainage may be beneficial to reduce morbidity and long-term sequelae of PID.
C-Reactive Protein ; Pelvic Inflammatory Disease ; Abscess ; Neutrophils ; Oophoritis ; Salpingitis ; Abdominal Abscess ; Lymphocytes

Prevotella bivia (P. vivia) has a high proliferative potential in the presence of estrogen. Therefore, its involvement in vaginal tract infections, such as endometritis and pelvic inflammatory disease, has been well described in the literature. We experienced a very rare case of a 40-year old woman with a 6-cm abscess on the cuff who presented with a large amount of vaginal discharge and nausea two months after laparoscopic supracervical hysterectomy. Our case indicates that clinicians should be aware of the possibility of P. vivia infections although rare.
Abscess ; Endometritis ; Estrogens ; Female ; Humans ; Hysterectomy* ; Nausea ; Pelvic Inflammatory Disease ; Prevotella* ; Vaginal Discharge

PURPOSE: Diagnosis of pelvic inflammatory disease (PID) is based on clinical history and examination; however, it may be difficult to distinguish from other disease entities. Multidetector computed tomography (MDCT) is a useful radiologic modality, which can be performed in an emergency department (ED). The aim of the current study was to clarify the MDCT characteristics of clinically severe PID by comparison of patients with clinically more severe and less severe forms of PID. In addition, we evaluated the independent predictors of MDCT findings in the severe PID group. METHODS: We conducted a retrospective study of female patients with symptoms and signs of PID who visited the ED at our institution during a five-year period. Patients who underwent abdominal MDCT and were diagnosed with PID were retrospectively enrolled in the study. For determination of CT characteristics, each patient was evaluated for pelvic edema, amount of ascites, Hounsfield units (HU) of ascites, salpingitis, oophoritis, intrauterine devices, peritoneal fat infiltration, cervicitis, abnormal endometrial enhancement, tubo-ovarian abscess, adjacent bowel wall thickening, localized ileus, and perihepatitis. Patients were divided into two groups: clinically more severe and less severe forms of PID. Patients having the clinically more severe form of PID were defined as follows: (1) initial body temperature over 38.3degrees C, (2) initial systolic blood pressure < 90 mmHg, (3) intractable abdominal pain, or (4) uncontrollable nausea or vomiting despite medication. We compared data between the two groups. RESULTS: A total of 136 patients were enrolled in this study. Thirty eight patients had the clinically more severe form (28%) and 98 patients had the less severe form (72%). In comparison with subjects in the group having the less severe form, the amount of ascites (p<0.001), salpingitis (p<0.05), and tubo-ovarian abscess (p<0.01) differed statistically between the groups. The HU value of ascites in the more severe group, 19.56+/-11.14 HU, was significantly greater, compared with that of the group having the less severe form. Results of multivariate logistic regression analysis revealed an association of the amount of ascites, a high HU value, and atubo-ovarian abscess with increased odds of the more severe form (adjusted OR 3.25, 95% CI 1.01-10.45; adjusted OR 5.84, 95% CI 1.80-18.95; and adjusted OR 8.42, 95% CI 1.73-40.96, respectively). CONCLUSION: Patients with clinically more severe PID show more clinically important findings on MDCT, such as a greater amount of ascites, higher HU value of ascites, and tubo-ovarian abscess. Leukocytosis, increased neutrophil percentage, and elevated CRP were observed in patients with severe PID.
Abdominal Pain ; Abscess ; Ascites ; Blood Pressure ; Body Temperature ; Edema ; Emergencies ; Female ; Humans ; Ileus ; Intrauterine Devices ; Leukocytosis ; Logistic Models ; Multidetector Computed Tomography ; Nausea ; Neutrophils ; Oophoritis ; Pelvic Inflammatory Disease ; Pelvic Pain ; Retrospective Studies ; Salpingitis ; Uterine Cervicitis ; Vomiting

Background: Pelvic inflammatory disease (PID) is an acute infection of the upper female genital tract, which may involve the uterus, fallopian tubes and ovaries. Tubo-ovarian abscess (TOA) is a complication of Pelvic Inflammatory Disease. Different methods are being utilized to predict the failure of medical management of TOA. Neutrophil-lymphocyte ratio (NLR) has been proposed as a significant marker for diagnosis in PID. Objective: To compare NLR and sonographic TOA volume between patients who responded to medical management versus patients with failed medical management, and who eventually underwent surgery. Methods: This is a cross-sectional study done by reviewing the hospital records of patients admitted for TOA in a tertiary hospital, from 2014 to 2018. Demographic details of the patients, computed NLR values and TOA volumes were gathered and analyzed. Results: There was no statistical difference between the group who responded to treatment (medical group) versus the group of patients with failed medical management (surgical group) in terms of age, gravidity, parity and mean volume of the TOA. There was a statistically significant difference between the mean NLR of the two treatment groups. Conclusion Patients diagnosed with TOA, and with failed medical management have significantly higher levels of NLR compared with patients who responded to medical treatment. This positive association can be explored in future researches to validate NLR as a predictor of medical treatment failure for patients with TOA. NLR can also be potentially utilized as novel marker to indicate need for earlier surgical management to decrease the patient’s risk for sepsis.
Pelvic Inflammatory Disease

Fitz-Hugh-Curtis syndrome is a condition in which, as a result of pelvic inflammatory disease, the liver capsule becomes involved with inflammatory exudate that later leaves violin string adhesions. Although in the past Neisseria gonorrhea was thought to be the only etiological agent, recent data indicate that Chlamydia trachomatis may play an important role in perihepatitis. Perihepatic adhesions may be an aftereffect of the acute hepatic episode, and because the cause of ectopic pregnancy is thought to be salpingitis, women with an ectopic pregnancy may have a higher prevalence of coexisting perihepatic adhesion. The incidence of this conditon in ectopic gestation was reported to be 14-34 %. Direct observation of the liver and pelvis through laparoscope is the most definitive method of diagnosing salpingitis and perihepatitis. Standard treatement regimens recommended for salpingitis are adequate also for treatement of perihepatitis. We have experienced two cases of Fitz-Hugh-Curtis syndrome associated with ectopic pregnancy, and report with the brief review of the literatures.
Chlamydia trachomatis ; Exudates and Transudates ; Female ; Gonorrhea ; Humans ; Incidence ; Laparoscopes ; Liver ; Neisseria ; Pelvic Inflammatory Disease ; Pelvis ; Pregnancy ; Pregnancy, Ectopic* ; Prevalence ; Salpingitis

Fitz-Hugh-Curtis syndrome (FHCS)-inflammation of the liver capsule (Perihepatitis) associated with genital tract infection-occurs in 4~14% of patients with pelvic inflammatory disease (PID). Generally presenting as sharp, pleuritic right upper quadrant pain, usually but not always accompanied by signs of salpingitis. It needs differential diagnosis such as cholecystitis, pyelonephritis. The pathogenesis of FHCS is incompletely understood. But Neisseria gonorrhoeae and Chlamydia trachomatis are thought to be the primary causative germs of FHCS. We make a report about FHCS in 19-year-old woman who had been sexual history recently.
Chlamydia ; Chlamydia Infections ; Chlamydia trachomatis ; Cholecystitis ; Diagnosis, Differential ; Female ; Hepatitis ; Humans ; Liver ; Neisseria gonorrhoeae ; Pelvic Inflammatory Disease ; Peritonitis ; Pyelonephritis ; Salpingitis ; Young Adult

No abstract available.
Female ; Female* ; Humans ; Infertility* ; Pelvic Inflammatory Disease*

Aims: This study was designed to evaluate awareness and knowledge of pelvic inflammatory disease (PID), its risk factors and diagnostic procedures among female undergraduates in tertiary institutions in Rivers State, Nigeria. Methodology and results: A questionnaire-based survey design was conducted among 325 undergraduate students. Completed questionnaires were retrieved immediately. Descriptive and inferential (chi-square test) statistical tools were used for data analysis. Out of the 325 respondents, 186(57.2%) had heard of PID, 162(49.8%) did not know the possible risk factors of PID, 161(49.5%) perceived their awareness level of PID to be poor, while 30(9.2%) had good awareness level of PID. The majority 185(56.9%) of the respondents, do not know the mode of transmission of PID. There was a statistically significant relationship between the student’s age and the level of awareness statement at (p<0.05). On the student’s knowledge, only the statement: Do you know PID could be symptomless, showed a statistically significant relationship with the student’s course of study (χ2=12.815, p=0.00). Conclusion, significance and impact of study Most respondents have heard of PID via social media and seminars and have even seen those who had the disease. They still claim that their awareness level was poor since they do not know the mode of transmission and ill effects of PID, and so they cannot be protected against the disease. A sensitization campaign on risk factors, symptoms and mode of spread of the disease has to be carried out in the institutions to save the students at high risk of the infection.
Pelvic Inflammatory Disease ; Student Health Services