What are the symptoms and treatment options for a pelvic abscess?

From the Guidelines

A pelvic abscess requires prompt medical attention and typically involves a combination of antibiotics and drainage, with the primary treatment being surgical drainage, as recommended by the most recent guidelines 1. The symptoms of a pelvic abscess can include severe abdominal pain, fever, and vaginal discharge, and if left untreated, can lead to serious complications such as sepsis or infertility. The recommended treatment approach is as follows:

• Broad-spectrum intravenous antibiotics should be started immediately, with a common regimen including:
  • Ceftriaxone 2g IV once daily
  • Metronidazole 500mg IV every 8 hours
  • Doxycycline 100mg IV every 12 hours
• Abscess drainage is crucial and should be performed as soon as possible, with options including:
  • Ultrasound-guided percutaneous drainage
  • CT-guided drainage
  • Surgical drainage (laparoscopy or laparotomy) if minimally invasive methods are not feasible
• Antibiotic therapy should continue for at least 14 days, with a transition to oral antibiotics once clinical improvement is observed.
• Follow-up imaging (ultrasound or CT) should be performed to ensure complete resolution of the abscess.
• Identify and treat the underlying cause (e.g., pelvic inflammatory disease, diverticulitis, appendicitis) to prevent recurrence, as emphasized in the guidelines for management of intra-abdominal infections 1. The combination of antibiotics and drainage is essential because antibiotics alone may not penetrate the abscess cavity effectively, and drainage reduces the bacterial load and allows better antibiotic penetration, as noted in the guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections 1. In patients with anorectal abscess, the timing of surgery should be based on the presence and severity of sepsis, and in fit, immunocompetent patients with a small perianal abscess and without systemic signs of sepsis, outpatient management may be considered, as suggested by the guidelines for anorectal emergencies 1. Additionally, the use of wound packing after anorectal abscess drainage remains unproven, and its use should be left to individual unit policy and patient discussion, as stated in the guidelines for anorectal emergencies 1. Prompt treatment is crucial to prevent complications such as sepsis or infertility, and the decision to hospitalize a patient with a pelvic abscess should be based on the discretion of the healthcare provider, taking into account factors such as the severity of the illness, the patient's ability to follow an outpatient oral regimen, and the presence of any surgical emergencies, as recommended by the guidelines for the treatment of sexually transmitted diseases 1.

From the Research

Symptoms of Pelvic Abscess

• Pelvic abscesses can cause a range of symptoms, including pain in the hip, flank, or pelvic area, as well as systemic symptoms such as sepsis 2
• The symptoms can vary depending on the size and location of the abscess, as well as the underlying cause 3

Diagnosis of Pelvic Abscess

• Imaging modalities such as ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI) are effective in diagnosing and staging the severity of pelvic abscesses 2, 4, 5
• Laboratory tests, such as blood cultures and complete blood counts, can also be helpful in diagnosing pelvic abscesses 4, 6

Treatment Options for Pelvic Abscess

• Treatment options for pelvic abscesses include medical management with antibiotics, percutaneous drainage, and surgical drainage 2, 3, 4, 5
• Percutaneous drainage is a minimally invasive procedure that can be effective in treating pelvic abscesses, especially those that are accessible via a transgluteal approach 4, 5
• Surgical drainage may be necessary for larger or more complex abscesses, or those that are not responsive to percutaneous drainage 2, 3
• Transvaginal ultrasound-guided aspiration is a less invasive approach that can be effective in treating pelvic abscesses in women 6

Factors Influencing Treatment Outcome

• The size and location of the abscess, as well as the presence of septations or other complications, can influence the outcome of treatment 3, 6
• The underlying cause of the abscess, such as a post-surgical or infectious etiology, can also impact treatment outcome 2, 4
• Patient factors, such as age and overall health status, can also influence treatment outcome 4, 5