MADE BY:-RAHIM DAD1st Group- 5th Year

{Also known as “PELVIC CELLULITIS”}

DEFINATION:-Inflammation of the tissue adjacent to the uterus, particularly in the broad ligament.

Infection spreads via lymphatics through uterine wall to connective tissue of broad ligament or entire pelvis. From Gorrie et al., 1994.

ETIOLOGY:-•The infection gains access following:•Delivery and abortion through placental site or from lacerations of the cervix, vaginal vault or lower uterine segment.•Acute infections of the cervix, uterus and tubes•Caesarean section or hysterectomy-abdominal or vaginal •Secondary to pelvic peritonitis•Carcinoma cervix or radium introduction•Parametritis: lateral, anterior, posterior•Pancellulitis• Exudative•Abscess

PATHOGENESIS:-Pathogenic or conditionally pathogenic flora enters the parameter in the trauma of the uterus, or - less frequently -lymphogenous or hematogenous route from the adjacent foci of infection (adnexitis, endocervicitis, colpitis). After the introduction of infection in the parameters they produce diffuse inflammatory infiltrate, which can fester (at the present level of care rarely happens), dissolve, or acquire a chronic course. Infiltrate is usually located in certain areas, from the anterior neck to the lateral edges of the bladder to the anterior abdominal wall, from the anterolateral parts of the cervix - the crural arch and the lateral abdomen, posterolateral parts of the neck - to the walls of the pelvis, from the back of the neck - to direct intestine.

ACUTE:-•The onset is usually insidious and appears about 7-10 days following initial infection.•The temperature rises to about 38 C. Pain is not a prominent feature, may be dull aching deep in the pelvis.•On examination, the PL rate is raised proportionate to the temperature. There is generalised deep tenderness on lower abdomen. Rigidity is absent because the lesion is extra peritoneal. Pelvic examination reveals hot and tender vagina. There is an indurated tender mass usually unilateral which extends to the lateral pelvic wall and to which the uterus is firmly fixed. The uterus is pushed to the contralateral side.•An abscess formation is featured by spiky rise of temperature, toxic look and fluctuant swelling in the regions mentioned earlier.

DIAGNOSIS:-•Persistent increase in ESR.• With the development of abscesses infiltrate:- neutrophilic leukocytosisoccur shift to the left,• Dysproteinemia, •In bimanual study:- determined shortening and smoothing of the posterior or lateral vaginal vault, a more pronounced by the defeat (or uniformly - in total infiltration). •The uterus is not fully contoured, as included in the inflammatory infiltrate in part or in whole. Then the side of the uterus is defined infiltrate - a dense consistency.• Signs of peritoneal irritation are absent. •Palpation of the abdomen at the beginning of the disease is painless, when a festering belly it becomes sensitive to palpation.• Complications can arise when late diagnosis of infiltration and the development of abscesses - a breakthrough of abscess in the free abdominal cavity, rectum, and bladder.

TREATMENT:-•Begin with a broad spectrum antibiotic drug, or fluoroquinolone (ciprofloxacin) in combination with metronidazole for 5-7 days. •The woman is on strict bed rest, cold press done on the lower abdomen, •Intravenous infusion of calcium chloride and 150 ml of 3% solution. If festering abscess is opened through the posterior vaginal vault or from the anterior abdominal wall (extraperitoneal). •In case of chronic process ,daily prednisalone dose of 20 mg for 10 days followed by NSAIDs(Indomethacin), with normalization of blood parameters.• The disease is reversible but requires a long time hence; for,4-6 months,a spa treatment with the use of mud vaginal tampons, irrigation, or hydrogen sulfide baths, pelvic massage must be followed

COMPLICATIONS:-

can arise when late diagnosis of infiltration and the development of abscesses - a breakthrough of abscess in the free abdominal cavity, rectum, and bladder.