1. MADE BY:-
RAHIM DAD
1st Group- 5th Year
{Also known as “PELVIC CELLULITIS”}

2. DEFINATION:-
Inflammation of the tissue adjacent
to the uterus, particularly in the
broad ligament.
Infection spreads via
lymphatics through uterine
wall to connective tissue of
broad ligament or entire pelvis.
From Gorrie et al., 1994.

3. ETIOLOGY:-
•The infection gains access following:
•Delivery and abortion through placental site or from
lacerations of the cervix, vaginal vault or lower
uterine segment.
•Acute infections of the cervix, uterus and tubes
•Caesarean section or hysterectomy-abdominal or
vaginal
•Secondary to pelvic peritonitis
•Carcinoma cervix or radium introduction
•Parametritis: lateral, anterior, posterior
•Pancellulitis
• Exudative
•Abscess

4. PATHOGENESIS:-
Pathogenic or conditionally pathogenic flora enters the
parameter in the trauma of the uterus, or - less frequently -
lymphogenous or hematogenous route from the adjacent foci
of infection (adnexitis, endocervicitis, colpitis). After the
introduction of infection in the parameters they produce
diffuse inflammatory infiltrate, which can fester (at the present
level of care rarely happens), dissolve, or acquire a chronic
course. Infiltrate is usually located in certain areas, from the
anterior neck to the lateral edges of the bladder to the anterior
abdominal wall, from the anterolateral parts of the cervix - the
crural arch and the lateral abdomen, posterolateral parts of the
neck - to the walls of the pelvis, from the back of the neck - to
direct intestine.

6. ACUTE:-
•The onset is usually insidious and appears about 7-10 days
following initial infection.
•The temperature rises to about 38 C. Pain is not a prominent
feature, may be dull aching deep in the pelvis.
•On examination, the PL rate is raised proportionate to the
temperature. There is generalised deep tenderness on lower
abdomen. Rigidity is absent because the lesion is extra
peritoneal.
Pelvic examination reveals hot and tender vagina. There is an
indurated tender mass usually unilateral which extends to the
lateral pelvic wall and to which the uterus is firmly fixed. The
uterus is pushed to the contralateral side.
•An abscess formation is featured by spiky rise of
temperature, toxic look and fluctuant swelling in the regions
mentioned earlier.

7. DIAGNOSIS:-
•Persistent increase in ESR.
• With the development of abscesses infiltrate:- neutrophilic leukocytosis
occur shift to the left,
• Dysproteinemia,
•In bimanual study:- determined shortening and smoothing of the posterior
or lateral vaginal vault, a more pronounced by the defeat (or uniformly - in
total infiltration).
•The uterus is not fully contoured, as included in the inflammatory infiltrate
in part or in whole. Then the side of the uterus is defined infiltrate - a dense
consistency.
• Signs of peritoneal irritation are absent.
•Palpation of the abdomen at the beginning of the disease is painless, when
a festering belly it becomes sensitive to palpation.
• Complications can arise when late diagnosis of infiltration and the
development of abscesses - a breakthrough of abscess in the free abdominal
cavity, rectum, and bladder.

8. TREATMENT:-
•Begin with a broad spectrum antibiotic drug, or
fluoroquinolone (ciprofloxacin) in combination with
metronidazole for 5-7 days.
•The woman is on strict bed rest, cold press done on the lower
abdomen,
•Intravenous infusion of calcium chloride and 150 ml of 3%
solution. If festering abscess is opened through the posterior
vaginal vault or from the anterior abdominal wall
(extraperitoneal).
•In case of chronic process ,daily prednisalone dose of 20 mg
for 10 days followed by NSAIDs(Indomethacin), with
normalization of blood parameters.
• The disease is reversible but requires a long time hence;
for,4-6 months,a spa treatment with the use of mud vaginal
tampons, irrigation, or hydrogen sulfide baths, pelvic massage
must be followed

9. COMPLICATIONS:-
can arise when late diagnosis
of infiltration and the
development of abscesses - a
breakthrough of abscess in the
free abdominal cavity, rectum,
and bladder.