Incision and drainage of pelvic abscess through the vagina

Incision and drainage of pelvic abscess through the vagina

Whenever possible a pelvic abscess should be drained through the vagina. Fortunately, the majority of abscesses in the female, regardless of cause, will tend to localize in the cul de sac at the base of the broad ligament. Timing of the drainage is of basic importance. The surgeon must be sure that the abscess cavity is fixed to the vaginal wall and that pus is present and not brawny indurated tissue. If it is not fixed, an ill-advised attempt to drain the abscess may result in damage to bowel and the possibility of contaminating the general peritoneal cavity. The surgeon will accomplish little if the drainage is made into an area of porky induration. If there is any doubt about the fixation or the presence of pus the operation should be delayed until these two criteria are thoroughly established.

Incision and drainage of pelvic abscess through the vagina

Incision and drainage of pelvic abscess through the vagina

A soft, tender bulging mass behind the cervix which is fixed to the vaginal epithelium may be drained without danger.

Textbook of surgery: Complications Following Abdominal Operations

Figure 1. The patient is placed in the lithotomy position, the cervix exposed and traction applied to it with a tenaculum. Note the fixation of the abscess to the vaginal wall. In all probability the uterus will not descend into the vaginal canal to any extent because of the fixation. The abscess cavity is shown in relation to other anatomical landmarks.

Figure 2. The cervix is elevated toward the urethra and the bulge of the abscess is apparent in the posterior fornix. An incision is made in the vaginal epithelium in the midline over the abscess cavity at the point of maximum fluctuation.

drainage of pelvic abscess

Incision and drainage of pelvic abscess

Figure 3. Maintaining the cervix on upward traction with the tenaculum, the surgeon thrusts a Kelly clamp into the abscess cavity.

Figure 4. An exploratory finger is introduced into the opening and the incision widened by blunt dissection.

Figure 5. The cervix is maintained on traction while the assistant steadies the lower edge of the incision with forceps. The surgeon then aspirates the cavity with a suction tip.

Incision and drainage of pelvic abscess

Incision and drainage of pelvic abscess through the vagina

Figures 6 and 7. Gauze-filled drains are introduced into the cavity and sutured to the vaginal epithelium.

complications drainage of pelvic abscess through the vagina

Incision and drainage of pelvic abscess through the vagina

 

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