[Gynecological laparoscopy] 4K laparoscopic treatment of pelvic abscess incision and drainage

Pelvic abscesses are one of the common emergencies in women of childbearing age, mainly including tubal pyosalpinx, ovarian pyosalpinx, tubo-ovarian abscesses (TOA) and abscesses caused by acute pelvic connective tissue inflammation. TOA involves the fallopian tubes and (or) ovaries, which is more serious than simple tubal or ovarian pyosalpinx.

Once pelvic abscesses develop into septic shock and sepsis, they seriously threaten the patient's life, so timely and correct diagnosis and treatment are particularly important.

People with the following risk factors or predisposing factors are more likely to get the disease.

1. History of unclean sexual intercourse;

2. Placement of intrauterine contraceptive device;

3. Decreased immunity:

4. Long-term drinking and smoking;

5. Women of childbearing age: usually around 30 to 50 years old;

6. Acute pelvic inflammatory disease not treated in time or recurring;

7. History of abdominal surgery;

8. Multiple artificial abortions;

9. Artificial pregnancy;

10. Diabetes;

11. Immune system deficiency;

12. Low body mass index.

Most patients have atypical symptoms, usually manifested as lower abdominal pain, high fever, anal distension, etc.

1. Lower abdominal pain: often manifested as repeated lower abdominal pain, which is persistent and aggravated in paroxysmal ways, and cannot be relieved by changing body positions.

2. Fever: When the infection is severe, it can cause systemic symptoms of fever with (or) chills, and the body temperature is usually high, up to 39 degrees Celsius or above; the duration of high fever varies according to the changes in the condition, and some even last up to 10 days. In severe cases, the body temperature does not rise but falls.

3. Anal swelling: When pus flows into the deep pelvic cavity, anal swelling and defecation sensation may occur.

4. Irregular vaginal bleeding and pus: Purulent secretions are discharged through the vagina, and purulent secretions can be found, which may be mixed with blood. In severe cases, purulent urine or purulent stools may be discharged through the urethra or anus.

5. Palpable mass in the abdomen: When the abscess is localized, a mass can be palpated on one or both sides of the lower abdomen, with a noticeable sense of fluctuation.

6. Shock symptoms: It is a manifestation of the abscess breaking through the abdominal cavity. The condition may suddenly worsen or the lower abdominal pain may continue to intensify and turn into pain in the whole abdomen, accompanied by nausea, vomiting, chills, followed by a weak and rapid pulse, pale complexion, sweating, and a sharp drop in blood pressure.

Hospitalization is recommended for pelvic abscesses, and the preferred treatment is intravenous antibiotics. The principle of antibiotic application is mainly broad-spectrum antibiotics, covering the common pathogens of pelvic abscesses.

Surgical treatment: Mainly used to treat tubo-ovarian abscesses or pelvic abscesses that are not satisfactorily controlled by antibiotics, and laparoscopic surgery is the preferred choice.

4K ultra-high-definition laparoscopic surgery: Compared with abdominal surgery, laparoscopic surgery has significantly lower postoperative anal gas discharge time, postoperative blood picture recovery time, hospital stay, postoperative wound infection rate, postoperative intestinal obstruction and postoperative recurrence rate than the abdominal surgery group. The advantages of laparoscopic treatment are as follows: the field of view under laparoscopy is fully exposed, the field of view is clearer, and the color is real. It can not only explore the pelvic cavity, but also the lens can be reversed upward to explore the abdominal liver diaphragm, which can clearly define the scope of the lesion and completely remove abscesses and necrotic tissues; laparoscopic surgery has the advantages of small incision, less surgical interference, less intraoperative bleeding, more thorough and effective treatment, and low incidence of incision infection; the intraoperative impact on the intestinal tract is small, and the incidence of postoperative pelvic adhesion is low, which is conducive to the retention of reproductive function.

Case

Color Doppler ultrasound examination showed that the patient had low-echo masses in the bilateral adnexal areas, with the right side measuring about 61×33mm and the left side measuring about 69×35mm; blood routine examination showed that the white blood cell count was 16.58×10^9/L, the neutrophil ratio was 76.7%; high-sensitivity C-reactive protein: 47.50mg/L. The doctor considered it to be "bilateral adnexal masses" with infection, and did not rule out the possibility of pelvic abscess. Considering that the patient had a large pelvic mass and bilateral adnexa were visible, there were surgical indications and no contraindications for surgery.

The patient's pelvic condition was observed during the laparoscopic operation: the pelvic cavity was completely covered with pus, and the uterus, bilateral adnexa (ovaries and fallopian tubes) were densely adhered to the greater omentum, rectum, and pelvic wall. Note: During the operation, the adhesions must be carefully loosened one by one, otherwise it may cause organ perforation.

When the laparoscopic operation reached the stage of bilateral adnexa separation, due to the high pressure in the bilateral adnexa abscess cavity, pus burst out instantly, and then a large amount of pus flowed out from it. The doctor immediately performed laparoscopic pelvic abscess removal and bilateral fallopian tube abscess high-pressure lavage on the patient. Considering her fertility requirements, the adnexa were retained. The patient bled 20ml during the operation, and about 100ml of pus was drained. She was able to get out of bed and move 6 hours after the operation.

Pelvic abscess seriously threatens women's reproductive health, so timely and correct diagnosis and treatment are particularly important. Fortunately, the patient received timely treatment and the operation was successful.

Laparoscopic early diagnosis and treatment can not only avoid blind treatment and reduce misdiagnosis, but also completely eliminate the lesions, separate adhesions under direct vision, timely incision and drainage of abscesses, and adequate flushing and cleaning of the pelvic cavity, which not only promotes the disappearance of inflammation, but also improves the patient's reproductive function. Conservative laparoscopic surgery has the least impact on reproductive and endocrine functions, and is especially suitable for young female patients who have not given birth.