Pelvic Inflammatory Disease




Abstract


Pelvic inflammatory disease, which is often simply referred to as PID, is a painful infectious and inflammatory disease that most commonly occurs in females below 25 years of age with a history of multiple sexual partners, the failure to use contraception, and living in areas with high incidence of sexually transmitted diseases. Additional risk factors for the development of PID include use of intrauterine devices, frequent vaginal douching, and menstruation. Starting as an asymptomatic or mildly symptomatic vaginal infection, PID ascends via the cervix to the upper genital tract, with infection and inflammatory changes of the fallopian tubes, ovaries, and uterus. If the disease progresses, it may ultimately spread to the abdomen with a predilection to the perihepatic region. This perihepatic involvement is known as Fitz-Hugh-Curtis syndrome and is characterized by pain and classic violin adhesions. Rarely, PID can occur in non-sexually active females.


Pelvic inflammatory disease is most often caused by chlamydia trachomatis, but neisseria gonorrheae, hemophilus influenza, gardnerella vaginallis, and bacteroides have also be implicated. Approximately 35% of cases of PID are polymicrobial in nature. Complications of PID include chronic pelvic pain, infertility, ectopic pregnancy, tubo-ovarian abscess, and perihepatitis (Fitz-Hugh-Curtis syndrome).




Keywords

pelvic inflammatory disease, pelvic pain, sexually transmitted illness, diagnostic ultrasonography, Fitz-Hugh-Curtis syndrome, tubo-ovarian abscess, ectopic pregnancy, chlamydia

 


ICD-10 CODE N73.9




Keywords

pelvic inflammatory disease, pelvic pain, sexually transmitted illness, diagnostic ultrasonography, Fitz-Hugh-Curtis syndrome, tubo-ovarian abscess, ectopic pregnancy, chlamydia

 


ICD-10 CODE N73.9




The Clinical Syndrome


Pelvic inflammatory disease, which is often simply referred to as PID, is a painful infectious and inflammatory disease that most commonly occurs in females below 25 years of age with a history of multiple sexual partners, the failure to use contraception, and living in areas with high incidence of sexually transmitted diseases ( Fig. 93.1 ). Additional risk factors for the development of PID include use of intrauterine devices, frequent vaginal douching, and menstruation. Starting as an asymptomatic or mildly symptomatic vaginal infection, PID ascends via the cervix to the upper genital tract, with infection and inflammatory changes of the fallopian tubes, ovaries, and uterus ( Fig. 93.2 ). If the disease progresses, it may ultimately spread to the abdomen with a predilection to the perihepatic region. This perihepatic involvement is known as Fitz-Hugh-Curtis syndrome and is characterized by pain and classic violin adhesions ( Fig. 93.3 ). Rarely, PID can occur in non-sexually active females.




FIG 93.1


Pelvic inflammatory disease is a painful infectious and inflammatory disease that most commonly occurs in females below 25 years of age with a history of multiple sexual partners, the failure to use contraception, and living in areas with high incidence of sexually transmitted diseases.



FIG 93.2


Intraoperative photograph showing the right adnexa of a patient with pelvic inflammatory disease. Notice the forceps pointing to marked hyperemia and edema of the inflamed fallopian tube and the thickening of the adjacent mesosalpinx.

(From Mentessidou A, Theocharides C, Patoulias I, et al. Enterobius vermicularis-associated pelvic inflammatory disease in a child. J Pediatr Adolesc Gynecol . 2016;29(2):e25–e27.)



FIG 93.3


Fitz-Hugh Curtis syndrome. Laparoscopic findings of the violin string between the peritoneum and the liver surface.

(From Wilamarta M, Huang K-G, Casanova J, et al. Laparoscopy is the best choice to diagnose Fitz-Hugh–Curtis syndrome. Gynecol Minim Invas Ther . 2013;2(4):135–136.)


Pelvic inflammatory disease is most often caused by chlamydia trachomatis, but neisseria gonorrhoeae, hemophilus influenza, gardnerella vaginalis, and bacteroides have also be implicated. Approximately 35% of cases of PID are polymicrobial in nature. Complications of PID include chronic pelvic pain, infertility, ectopic pregnancy, tubo-ovarian abscess, and perihepatitis (Fitz-Hugh-Curtis syndrome).




Signs and Symptoms


Severe pain in the lower abdomen and pelvis is invariably present with fever, nausea, and vomiting often confusing the diagnosis. Vaginal discharge is observed in most patients suffering from PID. The pain of PID is constant and characterized as aching or cramping in nature. Symptoms more likely occur toward the end of menses with gonorrhea and chlamydia associated infections tending to be of more sudden onset and fulminant evolution.


On physical examination, patients with PID will exhibit pain on movement of the cervix with associated uterine and adnexal tenderness. Mucopurulent cervical and vaginal discharge is invariably present. With more fulminant and more advanced cases, peritoneal signs, including rebound tenderness and guarding, may be noted. Adnexal fullness or mass may suggest tubo-ovarian abscess.

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Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Pelvic Inflammatory Disease

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