Pelvic Abscess Laparotomy

Overview

A pelvic abscess is a pus-filled (a yellowish-white infected fluid consisting of white blood cells, germs, and dead tissues) sac or pocket of inflamed tissue that most often occurs within the female pelvis. It is exceptionally rare in men, and if present, it may grow above the prostate. The abscess is caused by bacteria reaching the upper genital tract or by bacteria traveling from the lower genital tract.  It is a rare complication of pelvic infections or pelvic surgeries (gynecological or abdominal surgeries) that may present with pelvic or abdominal pain and tenderness with other related symptoms. 

A pelvic abscess is usually treated through antibiotics and surgical drainage through laparotomy or laparoscopy. 

This article discusses the pelvic abscess laparotomy, the procedure, its benefits, and the potential risks involved in the drainage procedure.

What is a Pelvic Abscess?

A pelvic abscess is a pocket of infected fluid and pus within the pelvic region. It may occur as a complication of:

• Pelvic infections like pelvic inflammatory disease (PID)
• Appendicitis (inflammation of the appendix)
• Lower genital tract infections
• Pelvic cancers
• Trauma
• Previous surgery (cesarean section, induced abortion, hysterectomy, etc.)
• Crohn's disease
• Diverticulitis (an infection or inflammation of one or more pouches in your digestive tract)

Symptoms may vary depending on the size and severity of the abscess; however, they may include:

• Pain and discomfort in the pelvic and abdominal area that aggravates when you move
• Fever (>104?) with chills and aches
• Pain during and after sex
• Abdominal bloating
• Nausea and vomiting
• Loss of appetite and weight loss
• Diarrhea and weakness

How is Pelvic Abscess Managed?

Small pelvic abscesses are usually treated through broad-spectrum antibiotics prescribed according to the blood culture report, which helps identify the organism causing the abscess.

However, larger pelvic abscesses are treated through surgical drainage and antibiotic treatment. Procedures used to drain a pelvic abscess include:

• Laparotomy (open) or laparoscopic drainage
• Ultrasound-guided aspiration drainage: Abscess is drained through the rectum in men and vaginally in women.
• CT-guided ( Computed Tomography) aspiration and drainage: Percutaneous Drainage.
• Endoscopic ultrasound-guided drainage (EUS-guided drainage): Effective and minimally invasive procedure.

What is a Pelvic Abscess Laparotomy?

A pelvic abscess laparotomy is a traditional open surgical approach that helps drain the pelvic abscess. Laparotomy is recommended when other drainage techniques (percutaneous drainage) fail to drain the abscess or when there is suspected abscess rupture. A single large incision (cut) is made in the abdominal cavity to gain access to the pelvic area and drain the abscess. The laparotomy method drains the abscess and treats any damaged tissue or organs.

How to a Prepare For a Pelvic Abscess Laparotomy?

A pelvic abscess laparotomy is an inpatient procedure (requires hospitalization for 2 to 3 days) which is safe and effective in treating a pelvic abscess.

• Your surgeon will conduct a physical examination and additional tests to confirm the size and the extent of the abscess spread. These include:
  • Blood analysis
  • X-ray of the affected body part
  • Ultrasound scan
  • CT (Computed Tomography) scan
  • MRI (Magnetic Resonance Imaging) 
• Your surgeon will review your medical history and ask for lifestyle conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), and other disorders so that necessary precautions are taken during and after the laparotomy to prevent any post-op complications. 
• History of drug allergies, previous surgeries, and accidents should be informed to your surgeon and the medications being taken.
• You will be advised to discontinue certain medications like blood thinners, aspirin, and other herbal supplements 2 weeks before pelvic abscess laparotomy.
• You must avoid alcohol 24 hours before the surgery since it may delay wound healing.
• You must not eat or drink 6 to 8 hours before the procedure.

What Happens During a Pelvic Abscess Laparotomy?

• You will be taken to an operating room and made to lie flat on the operating table.
• Your surgeon will administer general anesthesia (a numbing solution used to sedate you) through IV (intravenous) infusion. You will be unconscious throughout the procedure.
• The surgical site will be disinfected using an antiseptic solution to remove the surface contaminants.
• A single large incision will be made using a scalpel (a surgical blade) in the abdominal cavity to expose the pelvic area where the abscess is present. 
• The abscess will then be punctured and drained, and the surrounding organs or tissues treated if damaged. The pus drainage gradually shrinks the abscess sac.
• A catheter (thin tube) will be secured with surgical tapes for 2 to 3 days to facilitate complete drainage.
• The incision is closed using stitches.
• Your surgeon will place a surgical dressing over it.
• The entire procedure takes 1 to 2 hours.

What to Expect After a Pelvic Abscess Laparotomy?

You will be kept in the recovery room post laparotomy under observation for an hour or two. Your vitals like BP (blood pressure), respiratory rate, urine output, sugar level, pulse rate, and heart rate will be monitored, and once you regain consciousness, you will be shifted to your room. 

• Immediately after the surgery, you may experience mild pain, bruising, and discomfort, which can be managed through pain relief medications.
• You will be given bland liquid foods after 4 to 5 hours post-surgery.
• A urine catheter (thin tube-like device) will be placed for urination which is removed the next day. 
• You will be encouraged to walk the next day to prevent any formation of blood clots. 
• Your surgical dressing would be changed every 2 to 3 days and needs to be kept clean and dry.
• You will be advised to shower the next day; avoid soaking your dressing since it may lead to infection.
• You should avoid smoking and alcohol for at least 2 to 3 weeks since it may delay wound healing.
• You will be advised to refrain from lifting heavy objects and perform strenuous activities for 2 weeks post-surgery. 
• Recovery usually takes 4 to 6 weeks for a pelvic abscess laparotomy.

What Are The Benefits And Risks of Pelvic Abscess Laparotomy?

Pelvic abscess laparotomy is a common and safe procedure for surgical drainage of the abscess with the following benefits and risks:

Benefits

• Laparotomy provides a permanent solution.
• It rids you of the pain and discomfort that negatively impacts your quality of life.
• It not only drains the pelvic abscess but also helps to repair any damage occurred to the surrounding structures and organs.
• An open approach gives the surgeon clear access and visibility to evaluate the abscess and drain it completely. 

Risks

• Infection that may cause high-grade fever (>104?), with or without pus discharge.
• Allergic reactions due to anesthesia cause hives, rashes, nausea, dizziness, confusion, and shortness of breath.
• This leads to hematoma (bleeding underneath the skin near the surgical site causing swelling).
• Numbness around the abdominal or pelvic area due to nerve damage.
• Recurrence of the abscess.
• Formation of blood clots that may dislodge in the bloodstream and travel to the heart, brain, and lungs, causing life-threatening emergencies.

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