Objective: Our purpose was to assess the value of ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges presenting with the clinical picture of acute pelvic inflammatory disease.
Study design: Fifteen patients seen for acute pelvic inflammatory disease were treated by ultrasonographically guided transvaginal aspiration of pus from tuboovarian abscesses and pyosalpinges, followed by local and systemic administration of antimicrobal therapy.
Results: Improvement of symptoms followed aspiration in all patients. Temperature dropped to normal within 24 to 72 hours, and pain completely disappeared within 3 days. All patients were symptom free during a follow-up period of 6 months after aspiration.
Conclusion: Ultrasonographically guided transvaginal aspiration of pyosalpinges and tuboovarian abscesses is an effective, simple, and safe treatment. It avoided the need for laparoscopy or laparotomy.
PIP: The experience of 15 women with acute pelvic inflammatory disease (PID) suggests that ultrasonographically guided transvaginal aspiration of pyosalpinges and tuboovarian abscesses is a simple, safe, and effective treatment that can avert the need for laparoscopy or laparotomy. The mean age of these women was 28.5 years (range, 23-37 years). Twelve women had a prior history of PID. In seven women, vaginal ultrasonography detected inflammatory cystic swelling that was not evident from clinical examination. The mean diameter of the pelvic cystic masses was 67.3 mm (range, 40-90 mm). Aspiration of the abscess cavity was performed by suction. Only one patient required anesthesia. The antibiotic cefotaxime was injected directly into the abscess cavity. The procedure took a maximum of 15 minutes. An average of 57.7 ml of fluid was aspirated and Escherichia coli was identified in 12 patients. There was a marked decrease in leukocyte count and C-reactive protein after 3-7 days. Six patients left the hospital the day of the procedure; the remaining nine were hospitalized for 1-3 days. Systemic antibiotics were provided for use in the recovery period. All patients were symptom free at the six-month follow-up, although pelvic cystic swelling was observed in six women.