Abstract

PIP: 137 consecutive cases of pelvic abscess arising within the female genital tract admitted to Grady Memorial Hospital between January 1968 and December 1968 were studied to compare the outcome of conservative management with primary aggressive surgical treatment. The majority of women (about 70%) were between 21 and 40 years of age; 30% were nulliparous and 40% had had a pregnancy within 2 years prior to the pelvic abscess. 120 patients were managed conservatively: bedrest, fluid, and electrolyte replacement, nasogastric suction in 35 of these cases. The average hospital stay for the 120 patients was 9 days. There was an early failure rate of 10% who underwent exploratory laparotomy with total hysterectomy and bilateral salpingooophorectomy; rupture of the abscess occurred in approximately 4% of the conservatively managed cases. 16% of the remaining 97 patients followed for 2 1/2-8 years had delayed complications following discharge and required surgery for persistent symptoms or mass. There was no intestinal or urinary tract injury to these patients requiring surgery. 10 patients treated conservatively have subsequently become pregnant, with no reported ectopic pregnancies. Among 12 cases of ruptured pelvic abscess, postoperative morbidity was high. 17 cases of the 137 underwent initial laporotomy because of suspected rupture. These patients had total abdominal hysterectomy. Primary conservative therapy is favored over aggressive management via surgery, except in cases of questionable diagnosis, suspected rupture, or failure of the abscess to respond to initial conservative management.