Endometritis

Salpingitis
Oophoritis
Parametritis
Peritonitis
DDx
UTI
Early
pregnancy
complication,
Ectopic
pregnancy
Appendicitis,
diverticulitis
Complicated
ovarian tumor
Other causes of
lower ab pain

COMPLICATIONS
Tuboovarian
abscess,
polymicrobial,
50% bilateral
Tubal damage,
infertility and
future ectopic.
Fitz-Hugh-Curtis
syndr
Reinfection is
25%
Chronic PID,
adhesions,

PELVIC INFLAMMATORY DISEASE

PATHOLOGY
EPIDEMIOLOGY
CLINICAL FEATURES
Incidence variable
o Lower ab pain and
o Non specific, lack
Infection ascend to
tenderness
sensitivity and
10-13%,
the uterus resulting in
o
Deep
dysparunea
specificity
underestimated,
endometritis with
increasing
o Abnormal vaginal or o Positive predictive
plasma cell infiltration
Age, teens
value of clinical
cervical discharge
Tubes, mucosal
diagnosis is 65-90%

Sexual
activity,
early
o
Cervical
excitation
inflammation with
as compared to
coitus, multiple
and adnexal
swelling, redness and
laparoscopy
partners, often
tenderness
deciliation, polymorph
o Excess of WBC in
proceeded by STD
o Fever >38C
infiltration of the
the vagina present
(chlamydia, GC)
submucosa, exudate
o Adnexal mass in
in lower genital
with
2ndary
invasion
fills the lumen,
20% of cases
tract infection also
with anaerobes
adhesions and spread
o Raised ESR, WBC,
o Endometrial biopsy
to the serosal surface, Contraception
CRP
not recommended
pus from the fimbria
Pills? Protective
o Excess of
as routine
Ovaries and
Leukocytes in the
IUCD Cu releasing
investigation
formation of tubovagina
risk
ovarian abscess or
o
General
symptoms
Barrier protective
mass
depend on severity
Parity 75% are
nulliparous
INVESTIGATIONS
TREATMENT
CBC, CRP, Urine
Mild cases : Ambulatory Severe cases: Admit!
IV cephalosporin +
Antibiotic
metro till 24 h,
analysis and culture
Doxycycline
2x/day/14d
Indications
to
Admit:
improvement oral
HVS, Endocervical
+ metronidazole
Surgical emergency
doxycycline and
swab
cannot be excluded,
metronidazole
USS, adnexal mass or 2x/day/5d
(if
GC
suspected
add
Clinically
severe
abscess
disease, Tuboovarian
Clindamycine
Laparoscopy if there is ciprofloxocine single
dose)
abscess,
PID
in
Ofloxocine+
doubt about diagnosis
pregnancy, Lack of
metronidazole
or no improvement
Or
response
to
oral
Clindamycine
after 24-48 hours of
Ofloxocine
+
therapy,
Intolerance
to
proper treatment
metronidazole
oral therapy
Supportive therapy
BhCG

pelvic pain,
dysparunea,
dysmenorrhea
NOTES
Patients not improving on antibiotic
therapy should have laparoscopy
IUCD may be left in situ in women
with mild PID but should be
removed in sever cases
Tuboovarian abscess may be
drained abdominally,
lapaporoscopic or USS guided
aspiration on pelvic collection

*TUBERCULOSIS
Rare
Often secondary to pulmonary
TB
May present as pelviabdominal mass
Systemic symptoms, menstrual
disturbance, amenorrhoea,
infertility
Treated by antituberculous
drugs and surgery