NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Q: What evaluation is appropriate? A: This could be a pelvic abscess or a wound infection if the wound has closed. If a wound infection is present, drainage is necessary. If not, then most surgeons would obtain a CT or ultrasound study of the pelvis to examine for an abscess. On palpation, a pelvic abscess feels

like a tender mass on rectal examination. You establish a diagnosis of a pelvic abscess.

Q: What management plan is appropriate? A: Management of a pelvic abscess varies. Many surgeons would drain the abscess with a percutaneously placed catheter if accessible, and others would use open surgical drainage. Occasionally, transrectal or transvaginal drainage is appropriate if the abscess is intimate with either of those structures. Figure 8-19 shows ultrasound-guided drainage of a pelvic abscess. Once drained, an abscess resolves in most cases, and an associated cecal fistula would be unusual.

Figure 8-19: Ultrasound-guided drainage of a pelvic abscess. ( A ) Sagittal and ( B ) transverse views of the left adnexa in a woman with fever and pelvic pain reveal a lesion filled with fairly homogeneous echogenic material (calipers), representing an abscess. C: Under transvaginal ultrasound guidance, a needle (arrowheads) was inserted into the abscess and purulent material was aspirated. (From Doubilet PM, Benson CB, Benacerraf, BR. Atlas of Ultrasound in Obstetrics and Gynecology: A Multimedia Reference , 3rd ed. Wolters Kluwer Health; 2018, Fig. 35-10.) SAMPLE