¹Renad Mutlaq Alhanaki,²AMINA butt

¹College of medicine, Dar Al Uloom University, Riyadh, Saudi Arabia

²Master in clinical education leeds uk, Consultant obstetrician and Gynaecologist, Sulaiman AlHabib hospital

Background :
Pelvic fluid collection can complicate a variety of abdominal surgeries and gynecological inflammations; nevertheless, it is considered a rare pathological consequence after normal vaginal delivery. It is characterized by a wall of thick fibrous tissue that delineate an area of pus and necrotic tissues.
Case presentation :
A 31-year-old Saudi female presented with lower abdominal pain and dysuria 7 days following normal vaginal delivery. Apart from mild lower abdominal tenderness; the physical examination has been otherwise clear. The work-up showed leukocytosis and a high CRP level. The mild pelvic collection was shown on abdominal ultrasonography and the CT scan of the abdomen revealed an enhanced wall pelvic fluid collection measure of about 13*3.3 cm. The patient received injectable antibiotics, and the fluid was aspirated initially, via a transvaginal route under ultrasound guidance. Days later, further fluid was aspirated with the placement of a catheter inside.
Conclusion :
Physicians and obstetricians should have a high rate of suspicion for diagnosing Pelvic fluid collection. Injectable antibiotics and fluid aspiration with or without catheter placement are the mainstays for treatment.

Pelvic fluid collection, fluid aspiration, Saudi Arabia.

1) Day, Tania MD*; Schrager, Jason MD†; Hui, Kim MD*; Pelletier, Pierre MD‡ Large Pelvic Abscess After Uncomplicated Vaginal Delivery, Journal of Pelvic Medicine and Surgery: November 2008 - Volume 14 - Issue 6 - p 441-444 doi: 10.1097/SPV.0b013e3181901a85.

2) Desai NM, Tsukerman A. Vaginal Delivery. [Updated 2021 Oct 27]. In: StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559197/.

3) Toglia MR, Pearlman MD. Pelvic fluid collectionsfollowing hysterectomy and their relation to febrile morbidity. Obstetrics and Gynecology. 1994 May;83(5 Pt 1):766-770. PMID: 8164941.

4) F. Barbut, B. Carbonne, F. Truchot et al., “Surgical site infections after cesarean section: results of a five-year prospective surveillance,” Journal de Gynécologie, Obstétrique et Biologie de la Reproduction, vol. 33, no. 6, pp. 487–496, 2004.

5) Lisotti A, Cominardi A, Bacchilega I, Linguerri R, Fusaroli P. EUS-guided transrectal drainage of pelvic fluid collections using electrocautery-enhanced lumen-apposing metal stents: a case series. VideoGIE. 2020 May 29;5(8):380-385. doi: 10.1016/j.vgie.2020.04.014. PMID: 32821872; PMCID: PMC7426890.

6) C. P. Chen, M. H. Wang, L. F. Yeh, and W. Wang, “Rapid diagnosis and treatment of post-cesarean parametrial abscess by transabdominal ultrasound-guided needle aspiration,” Ultrasound in Obstetrics & Gynecology, vol. 15, no. 4, pp. 343- 344, 2000.

7) MDCM, SME.EasonMDA.AldisMDR.J.Seymour et al Pelvic fluid collections by sonography and febrile morbidity after abdominal hysterectomy Obstetrics & Gynecology Volume 90, Issue 1, July 1997, Pages 58-6.

8) Yumi Murayama, Tomohito Tanaka, Hiroshi Maruoka, Atsushi Daimon, Shoko Ueda, Masahide Ohmichi, "Pelvic Abscess after Cesarean Section Treated with Laparoscopic Drainage", Case Reportsin Obstetrics and Gynecology, vol. 2021, Article ID 8868608, 3 pages, 2021.

9) Faro C., Faro S. Postoperative pelvic infections. Infect Dis Clin North Am. 2008;22:653–663.

10) Brun JL, Castan B, de Barbeyrac B, et al; for the CNGOF; SPILF. Pelvic inflammatory diseases: updated French guidelines. J Gynecol Obstet Hum Reprod. Epub 2020 Feb 20.

11) Novak J. Uber Ursache and Bedeutung des physiologischen Ascites beim Weibe. Zentralbl Gynaekol 1922; 46: 854.

12) Davis JA, Gosink BB. Fluid in the female pelvis: cyclic patterns. J Ultrasound Med 1986; 5: 75– 79.

13) E. L. Ormsby,J. Geng,J. P. McGahan,J. R. Richards et al Pelvic free fluid: clinical importance for reproductive age women with blunt abdominal trauma Ultrasound in obstetrics and gynecology First published: 22 August 2005 https://doi.org/10.1002/uog.1981 https://doi.org/10.1002/uog.1981.

14) Dart R, McLean SA, Dart L. Isolated fluid in the cul-de-sac: how well does it predict ectopic pregnancy? Am J Emerg Med 2002; 20: 1– 4.

15) American Journal of Roentgenology 2008 191:5, 1352-1358 Transvaginal Drainage of Pelvic Fluid Collections: Results, Expectations, and Experience Anuradha Saokar, Ronald S. Arellano, Debra A. Gervais, Peter R. Mueller, Peter F. Hahn, and Susanna I. Lee.

16) Kairys N, Roepke C. Tubo-Ovarian Abscess. [Updated 2021 Jul 18]. In: StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448125/.

17) Nehring SM, Goyal A, Patel BC. C Reactive Protein. [Updated 2021 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441843/

18) Vincent Wong, Davide P. Cina,Olga Alexeeva ,John C. Hairston ,Stephanie Kielb ,Matthias D. Hofe et al Management of Recurrent Pelvic Fluid Collections in Adult Male Bladder Exstrophy Patients With Maintenance of Erectile Function UROLOGY VOLUME 125, P256-259, MARCH 01, 2019 December 20, 2018DOI:https://doi.org/10.1016/j.urology.2018.10.052.

19) Ramesh J. Bang J.Y. Trevino J. et al Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol. 2013; 28: 620-625.

20) Gjelland K, Ekerhovd E, Granberg S. Transvaginal ultrasound-guided aspiration for treatment of tubo-ovarian abscess: a study of 302 cases. Am J Obstet Gynecol 2005; 193:1323 –1330

Volume 05 Issue 08 August 2022

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