Infection of the residual pelvic organs or cellular tissues is not uncommon following hysterectomy, more in vaginal than abdominal one. It is more common in infected or potentially infected cases than in ‘elective’ non-infective cases.
Organisms: Escherichia coli and Bacteroides fragilis are the predominant organisms.
Pathology: The vaginal cuff may be indurated due to infected hematoma → cellulitis → abscess. The infection may spread to produce pelvic cellulitis, thrombophlebitis or tubo-ovarian mass.
Clinical features: Fever and lower abdominal or pelvic pain of varying degrees appear few days (3–4) following surgery.
Per vaginam: Discharge is offensive and the vaginal vault is indurated and tender. Speculum examination may reveal exposed vaginal cuff with purulent discharge coming through the gaping vault. Rectal examination reveals induration on the vault or its extension to one side (parametritis). Rarely, a fluctuant mass may be felt (pelvic abscess).
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