bubble_chart Overview

Inflammation of the female pelvic reproductive organs is often accompanied by varying degrees of pelvic peritonitis. In severe cases, the entire pelvic peritoneum undergoes inflammatory changes, and in rare instances, the inflammation may even spread throughout the entire abdomen, leading to diffuse peritonitis. Occasionally, due to pelvic peritonitis or inflammatory changes in other abdominal organs caused by sexually transmitted diseases, pus may accumulate in the lowest part of the abdominal cavity—the rectouterine pouch—forming a rectouterine abscess.

bubble_chart Etiology

1. Dissemination of acute salpingitis During acute inflammation of the fallopian tubes, pus from the lumen may spill through the abdominal ostium, or perisalpingitis may directly spread, causing inflammatory changes in the pelvic peritoneum.

2. Secondary to pelvic cellulitis.

3. Other surgical conditions Such as appendicitis or perforated diverticulitis.

bubble_chart Pathological Changes

The entire pelvic peritoneum is congested, with a large amount of serous exudate containing fibrin. In the chronic stage, the uterus, adnexa, and intestines become extensively adherent, forming a mass. The greater omentum adheres to other organs like a roof above the pelvic inlet, creating an encapsulated inflammatory mass. These adhesions serve a protective function by localizing the inflammation to the pelvis, preventing its spread throughout the abdomen. The absorptive capacity of the pelvic peritoneum is lower than that of the upper abdomen, which also limits toxin absorption. However, exudate may still persist within the adhesions, sometimes leaving behind multiple small abscesses. Some may completely resolve without a trace, except for dense adhesions.

bubble_chart Clinical Manifestations

Since acute pelvic peritonitis is rarely primary, most cases have a history of acute pelvic organ inflammation before onset.

Patients experience high fever, shivering, and a body temperature that may reach 40°C or higher. They suffer from severe cramp-like lower abdominal pain, which is persistent and often accompanied by nausea and vomiting, worsening with movement. Pain occurs during urination and defecation, sometimes with diarrhea or constipation. Patients prefer to lie with their legs flexed to relieve abdominal wall tension and pain. In severe cases, symptoms such as dysphoria, restlessness, general exhaustion, and even confusion, delirium, or unconsciousness may occur.

Signs: The abdominal wall is tense, rigid, and board-like, with severe tenderness and rebound pain. Patients resist palpation, especially in the lower abdomen. As a result, gynecological examination is nearly impossible and unsatisfactory even if attempted. The entire cervix and fornix are markedly tender. At this stage, doctors should not insist on performing a bimanual examination. Severe cases may present with shock, decreased blood pressure, grayish complexion, dry tongue, cold sweating, and later collapse, heart failure, or pulmonary edema. A diagnosis can be made based on the above clinical symptoms. White blood cell and neutrophil counts are elevated, and the erythrocyte sedimentation rate is significantly increased.

In the chronic stage, the reproductive organs may adhere to the greater omentum and intestines, forming irregular, fixed masses of varying sizes that are tender to palpation.

bubble_chart Diagnosis

Based on medical history, symptoms, and signs, the diagnosis is not difficult to make, but it should be differentiated from perforated acute appendicitis. Additionally, some diseases have symptoms similar to acute pelvic peritonitis, such as torsion of the pedicle of an adnexal tumor, rupture of a hematosalpinx, necrosis of uterine fibroids, etc. In particular, the peritoneal irritation symptoms caused by massive intra-abdominal bleeding (e.g., rupture of tubal pregnancy) can sometimes be extremely difficult to distinguish from the local signs of pelvic peritonitis or diffuse peritonitis. Moreover, a few cases of pelvic peritonitis may extend to the gallbladder, causing right upper quadrant pain and tenderness, which can easily be confused with the signs of cholecystitis. In such cases, a detailed medical history should be obtained, and other systemic conditions (such as body temperature, blood pressure, and general condition) should be considered to reach a diagnosis.

Chronic pelvic peritonitis is often accompanied by chronic salpingo-oophoritis and chronic uterine myometritis, so it typically presents with all the symptoms of chronic pelvic genital organ inflammation. The treatment principles are entirely the same, and there is no need for individual differentiation.

bubble_chart Treatment Measures

The treatment is the same as for acute salpingo-oophoritis. Due to the self-protective function of pelvic peritonitis, surgery should not be performed indiscriminately, as it may cause damage and spread the inflammation. Therefore, the treatment principle is entirely different from that of diffuse peritonitis. Non-surgical treatments such as systemic supportive therapy and infection control should be adopted. However, if an abscess forms, it should be drained via abdominal or vaginal incision.