Pelvic abscess is caused by an acute inflammatory lesion of the abdomen and pelvis that is not treated in a timely manner**, and inflammatory effusions accumulate and are confined to the pelvis. Abscesses are secondary to a variety of diseases such as perforation of appendicitis, rupture of the colon, inflammation of the pelvic adnexa, gastrointestinal tumors after surgery, etc. Because the pelvis is located in the lowest part of the abdominal cavity, inflammatory exudate or pus tends to flow in. Clinical symptoms include high fever, lower abdominal pain, and rectal and bladder irritation.
The patient, Ms. Zhang, had fever 10 days ago without obvious cause, accompanied by lower abdominal distension and ** swelling discomfort, after the local clinic reduced inflammation**, it was relieved, and the symptoms have worsened in recent days, and the infection indicators have increased significantly, combined with ultrasound and other imaging examinations, Ms. Zhang was diagnosed with pelvic abscess. Due to the large scope of pelvic abscess, severe symptoms, and ineffective conventional anti-inflammatory, the abscess is closely related to the rectum during surgery, and it is easy to be injured during surgery. But we can't wait any longer, in case the abscess ruptures and rushes into the abdominal cavity, it will directly lead to diffuse peritonitis, and even sepsis, septic shock, which is life-threatening.
For a time, there was a dilemma. At this critical juncture, Director Cheng Jian's team contacted the ultrasound department and wanted to try whether ultrasound-guided interventional puncture and catheter drainage could be performed, and Director Zheng Yu did an ultrasound examination for the patient as soon as possible, which showed that the scope of the abscess was large enough, but the location was indeed awkward, the surrounding area was full of intestinal echoes, and there were uterus and bladder in front.
Director Zheng Yu proposed that the ultrasound-guided puncture could be carried out, and after discussing the surgical process with Director Cheng Jian's team, under strict disinfection and monitoring, the patient was timely treated with ultrasound-guided pelvic abscess puncture and catheter drainage. Under the real-time monitoring of yin ultrasound, the 8F pig tail drainage tube was successfully placed in the abscess cavity quickly and accurately, and more than 100 ml of white pus was drained.
After combining anti-inflammatory**, the drain was removed on the 4th day after surgery, and the results of re-examination on the 5th day showed that the blood indicators decreased significantly to the normal range, and the abscess was significantly reduced by ultrasound. **The patient recovered well and was discharged from the hospital.
Pelvic abscess is punctured and catheterized for drainage.
01 Indications.
1) Imaging examination shows pelvic abscess and has a safe puncture path, and the abscess is large and/or has poor antibiotic effect.
2) Symptom relief of drug **, consolidation **2 After 3 weeks, the mass has not disappeared but has been localized.
3) History of multiple pelvic and abdominal surgeries or ** abscess, heavy pelvic and abdominal adhesions, and it is expected that laparotomy and laparoscopic surgery are difficult.
4) Those who are elderly and have poor physical fitness, combined with cardiopulmonary and other organ dysfunction, malnutrition and other diseases and cannot tolerate laparotomy and laparoscopic surgery.
02 Contraindications.
1) Severe coagulation dysfunction or severe bleeding tendency.
2) Those who have an early stage of abscess and the abscess has not yet liquefied.
3) If the abscess is difficult to show due to flatulence, etc.
4) There is no suitable way to advance the needle, and the puncture needle cannot avoid the intestinal tube, large blood vessels and important organs.
Author: Gao Xueyan, Department of Ultrasound Medicine.
Editor: Propaganda Section Strict.
Review: Zhang Di, Propaganda Section.