Encysted pus in the pouch of Douglas is called pelvic abscess.
Pelvic causes (common)
- Postabortal and puerperal sepsis.
- Acute salpingitis.
- Perforation of an infected uterus such as attempted uterine curettage in septic abortion or pyometra.
- Infection of pelvic hematocele usually following disturbed tubal pregnancy.
- Postoperative pelvic peritonitis following abdominal or vaginal operation.
- Irritant peritonitis following contamination of urine, bile, vernix caseosa, meconium (spilled during cesarean section), iodine containing dye used in hysterosalpingography or contents of ruptured ovarian cyst (sebum in dermoid cyst), etc.
Extrapelvic causes (rare)
Appendicitis, diverticulitis, ruptured gallbladder, perforated peptic ulcer usually produce generalized peritonitis. The condition may ultimately settle to the dependent pouch of Douglas and produces pelvic abscess.
Clinical features: Patient is ill from any of the causative factors mentioned earlier. But the localization of pus in the pouch of Douglas is evidenced by:
- Spiky rise of high temperature with chills and rigor.
- Rectal tenesmus—frequent passage of loose mucoid stool.
- Pain lower abdomen—variable degrees.
- Urinary symptoms—difficulty or even retention of urine.
General: The face is flushed with anxious look. Pulse rate is raised out of proportion to temperature.
- Tenderness and rigidity in lower abdomen.
- A mass may be felt in the suprapubic region— tender, irregular, soft, and resonant on percussion.
-The vagina is hot and tender.
- The uterus is pushed anteriorly; the movement of the cervix is painful.
-A boggy, fluctuant, and tender mass is felt in the pouch of Douglas.
-A separate mass may be felt through the lateral fornix.
Rectal examination defines precisely the mass in the pouch of Douglas.
Blood: There is high leukocytosis with increased polymorphs.
Bacteriological study: Swabs are taken from high vagina, endocervical canal and from the pus. Culture is done for both aerobic and anaerobic microorganisms.
Sensitivity of the microorganisms to antibiotics is also to be detected.
HOMEOPATHIC MANAGEMENT OF PELVIC ABSCESS: -
There are some medicines which can be helpful in tackling pelvic Abscess, it's symptoms and further Complications. Homoeopathic mode of treatment is based upon prescribing medicines on the basis of symptom similarity. The medicines which can be thought of use are:-
- Sepia succus
- Merc Sol
- Kreosotum etc