What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease refers to inflammation of female reproductive organs, connective tissue around the uterus, and pelvic peritoneum. Chronic pelvic inflammation often results from incomplete treatment in the acute phase, with a long onset of illness and a more stubborn condition. Bacteria retrogradely infect and reach the pelvic cavity through the uterus and fallopian tubes. But in real life, not all women will develop pelvic inflammatory disease, and the incidence is only a few. This is because the female reproductive system has a natural defense function. Under normal circumstances, it can resist the invasion of bacteria. Only when the body's resistance decreases or the natural defense function of the woman is damaged for other reasons, will the pelvic cavity be caused. The occurrence of inflammation.

Basic Information

English name: pelvic inflammatory disease
Visiting department: Gynecology
Multiple groups: Married women

Common causes: Postpartum or miscarriage, intrauterine surgical infection, poor menstrual hygiene, etc.
Common symptoms: Lower abdominal pain, fever, increased vaginal discharge, worsening after intercourse

Causes of pelvic inflammatory disease

1. Postpartum or postpartum infection

After delivery, the mother's constitution is weak, the cervical mouth is leaked due to lochia, and it is not closed in time. There is a peeling surface of the placenta in the uterine cavity, or the birth canal is damaged due to delivery, or there are placenta and fetal membrane residues. Invasion into the uterine cavity is likely to cause infection; post-abortion infection can occur during spontaneous abortion, medical abortion for too long a period of vaginal bleeding, or tissue residues in the uterine cavity, or inadequate aseptic operation of artificial abortion.

2. Infection after intrauterine surgery

Such as the placement or removal of IUD, curettage, tubal drainage, hysterosalpingography, hysteroscopy, submucosal uterine fibroid removal, etc., because of sexual life or surgical disinfection before surgery is not strict or preoperative Indications are not selected properly, and acute infections occur and spread after surgery; some patients do not pay attention to personal hygiene after surgery, or do not follow doctor's orders after surgery, which can also cause bacteria to infect and cause pelvic inflammatory disease.

3. Poor menstrual hygiene

If you do not pay attention to menstrual hygiene, use unclean sanitary napkins and pads, menstrual tub baths, menstrual intercourse, etc. can cause pathogens to invade and cause inflammation.

4. Inflammation of adjacent organs spreads directly

The most common are appendicitis and peritonitis. Because they are adjacent to the female reproductive organs, inflammation can directly spread and cause pelvic inflammation. In chronic cervicitis, inflammation can also pass through the lymphatic circulation and cause pelvic connective tissue inflammation.

5. Other

Acute attacks of chronic pelvic inflammatory disease.

Classification of pelvic inflammatory disease

1. Hydrosalpinx and fallopian tube cyst

After the fallopian tube is inflamed, the umbrella end is stuck and locked, and the tube wall leaks serous fluid, which slips into the lumen to form tubal hydrops; sometimes the tubal pus can also absorb hydrops and form hydrosalpinx. Formation of fallopian tube ovarian cysts.

2. salpingitis

It is the most common in pelvic inflammatory disease; the fallopian tube mucosa and interstitial tissues are thickened and fibrotic and become stranded due to inflammation, or the ovary, fallopian tubes and peripheral organs are adhered to form a hard and fixed mass.

3. Chronic pelvic connective tissue inflammation

Inflammation spread to connective tissue near the uterus and the ligament of the uterus and sacral ligament; the local tissue thickened, hardened, fan-shaped spread out to the pelvic wall, and the uterus was fixed or moved to the affected side.

Clinical manifestations of pelvic inflammatory disease

There are two types of pelvic inflammation: acute and chronic:

Acute pelvic inflammation

Its symptoms are lower abdominal pain, fever, and increased vaginal discharge. Abdominal pain is persistent and worsens after activity or intercourse. If the condition is severe, there may be chills, high fever, headache, and loss of appetite. Menstrual onset may increase menstrual flow and prolong menstruation. If pelvic inflammatory disease forms a pelvic abscess, it can cause symptoms of local compression, urinary frequency, pain, and difficulty urinating when urinating the bladder; rectal symptoms such as acute and severe after compression of the rectum can occur. Further development of acute pelvic inflammatory disease can cause diffuse peritonitis, sepsis, and septic shock, and severe cases can be life-threatening.

2. Chronic pelvic inflammation

It is due to the incomplete treatment of acute pelvic inflammatory disease or the poor constitution of the patient and the prolonged course of the disease. The symptoms of chronic pelvic inflammatory disease are lower abdomen swelling, pain and lumbosacral soreness, which are often exacerbated after fatigue, intercourse and before and after menstruation. Followed by abnormal menstruation, irregular menstruation. Some women may experience neurasthenia, such as lack of energy, general discomfort, and insomnia, for a long time. Often it is unhealed and recurrent, leading to infertility and tubal pregnancy, which seriously affects women's health.

Pelvic inflammatory disease examination

1. Direct smear of secretions

Sampling can be vaginal, cervical canal secretions, or urethral secretions, or peritoneal fluid (obtained through the posterior fornix, abdominal wall, or laparoscopy), as a direct thin-film smear, and dried with methylene blue or Gram stain. Those who see Gram-negative diplococci in polymorphonuclear leukocytes are infected with gonorrhea. Because the detection rate of cervical gonorrhea is only 67%, a negative smear does not exclude the presence of gonorrhea, and a positive smear is specific. Microscopic examination of Chlamydia trachomatis can be performed with a fluorescein monoclonal antibody dye, and any star-shaped flickering fluorescent spot observed under a fluorescence microscope is positive.

2. Pathogen culture

The source of the specimen is the same as above. It should be inoculated on Thayer-Martin medium immediately or within 30 seconds, and cultured in a 35 ° C incubator for 48 hours for bacteria identification. The new relatively fast chlamydia enzyme assay replaces the traditional chlamydia detection method, and mammalian cell culture can also be used to detect the chlamydia trachomatis antigen. This method is an enzyme-linked immunoassay.

Bacteriological culture can also obtain other aerobic and anaerobic strains, and use it as a basis for selecting antibiotics.

3. Back dome puncture

Posterior dome puncture is one of the most common and valuable diagnostic methods for gynecological acute abdomen. Through the puncture, the contents of the abdominal cavity or the uterine rectum, such as normal abdominal fluid, blood (fresh, old, coagulated silk, etc.), purulent secretions or pus, can make the diagnosis clearer. Microscopic examination of the puncture And training is even more necessary.

4. Ultrasound inspection

It is mainly B-type or gray-scale ultrasound scans and radiographs. This technology is 85% accurate for identifying masses or abscesses formed from the fallopian tube, ovarian and intestinal adhesions. However, mild or moderate pelvic inflammatory disease is difficult to show in B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis, the general condition of the patient is good. Laparoscopy can be performed on patients with pelvic inflammatory disease or suspicious pelvic inflammatory disease and other acute abdominal diseases. Laparoscopy can not only confirm the diagnosis and differential diagnosis, but also the degree of pelvic inflammatory disease. Preliminary determination.

6. Examination of male partners

This helps the diagnosis of pelvic inflammatory disease in women. The urethral secretions of the male companion can be used for direct smear staining or gonococcus culture. If positive, it is a strong evidence, especially in those with no symptoms or mild symptoms. Or you can find more white blood cells.

Pelvic inflammatory disease diagnosis

Minimum standard

Cervical lifting or tenderness of the uterus or tenderness of the attachment.

2. Additional standards

Body temperature exceeds 38.3 , cervical or vaginal mucus purulent secretion, vaginal secretion 0.9% NaCl smear see a large number of white blood cells, erythrocyte sedimentation rate, C-reactive protein increased; laboratory confirmed cervical Neisseria gonorrhoeae or chlamydia positive .

3. Specific criteria

Endometrial biopsy found histological evidence of endometritis. Transvaginal ultrasound or magnetic resonance imaging examination showed thickening of the fallopian tube wall, effusion of fluid, with or without pelvic effusion or fallopian tube ovarian abscess. Laparoscopy has: Abnormal PID discovery.

Those with a history of acute pelvic inflammation and symptoms and signs have no difficulty in diagnosis, but sometimes the patients have more symptoms without obvious history of pelvic inflammatory disease and positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be careful, so as not to make a hasty diagnosis and cause patients Burden of thought. Sometimes pelvic congestion or varicose veins in the broad ligament can produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to distinguish. Endometriosis is more pronounced with dysmenorrhea. If you can feel typical nodules, it can help diagnosis. Laparoscopy can be used when identification is difficult. Hydrosalpinx or fallopian ovarian cysts need to be distinguished from ovarian cysts. The former has a history of pelvic inflammatory disease. The mass is a sausage-shaped cyst with a thin cyst wall and adhesions around it. However, ovarian cysts are generally round or oval in shape and there are no Adhesion and freedom of movement. The pelvic inflammatory appendage mass is adherent to the surrounding, inactive, and sometimes confused with ovarian cancer. The inflammatory mass is cystic and the ovarian cancer is solid. A B-mode ultrasound examination can help identify.

Acute chronic pelvic inflammation can be diagnosed based on history, symptoms, and signs. But be sure to make a differential diagnosis. The main differential diagnoses of acute pelvic inflammatory disease are: acute appendicitis, ectopic pregnancy, torsion of ovarian cysts, etc .; the main differential diagnosis of chronic pelvic inflammatory disease are: endometriosis and ovarian cancer.

Differential diagnosis of pelvic inflammatory disease

Pelvic congestion syndrome

Presented as pain in the lumbosacral region and lower abdomen, radiation to the lower extremities, aggravation after standing and exertion. Examination of the cervix was purple-blue, but the uterus and appendages were normal and did not match the symptoms and signs of pelvic inflammatory disease. With B ultrasound, pelvic venography can be confirmed.

2. Endometriosis

The main manifestation is secondary dysmenorrhea with menstrual disorders or infertility. If there are tender nodules in the posterior wall of the uterus, the ligament of the uterus and the sacrum, and the depression in the posterior depression, the diagnosis can be made. In addition, patients with chronic pelvic inflammatory disease who have been ineffective for a long time should consider the possibility of endometriosis.

3. Ovarian tumor

Malignant ovarian tumors can also appear as pelvic masses, which are adherent, inactive, and tender, and are easily confused with inflammatory masses. However, its general health is poor, the condition develops rapidly, and the pain is persistent and has nothing to do with the menstrual cycle. B-ultrasound can reveal abdominal mass, which is helpful for diagnosis.

Pelvic Inflammation Treatment

Drug treatment

Antibiotics are the main treatments for acute pelvic inflammatory disease, including intravenous infusion, intramuscular injection or oral administration. Broad-spectrum antibiotics should be used in combination with anti-anaerobic drugs, paying attention to the course of treatment. And can be combined with traditional Chinese medicine treatment, in order to achieve better results.

2. Surgical treatment

If there is a mass such as hydrosalpinx or fallopian tube ovarian cyst, it is feasible to treat it; if there is a small infection, it may cause inflammation and the author should also treat it. Surgery is based on the principle of complete cure to avoid the chance of recurrence of the remaining lesions. Attachment or salpingectomy is performed. For young women, try to preserve ovarian function. Monotherapy for chronic pelvic inflammatory disease is less effective, and comprehensive treatment is appropriate.

3. physical therapy

Warm benign stimulation can promote local blood circulation in the pelvis. Improve the nutritional status of tissues and increase metabolism to facilitate absorption and resolution of inflammation. Commonly used are shortwave, ultrashortwave, ion penetration (can add various drugs such as penicillin, streptomycin, etc.), wax therapy and so on. Traditional Chinese medicine also has a method for treating Chinese herbal medicines.

4. Psychotherapy

General treatment relieves the patient's thoughts and concerns, enhances the confidence of treatment, increases nutrition, exercises the body, pays attention to the combination of work and rest, and improves the body's resistance.