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It is important to identify a retained fecalith and remove that infective nidus to decrease the morbidity in patients undergoing laparoscopic appendectomy for perforated appendicitis.

Objective To assess the predictive value of C-reactive protein (CRP) level for early septic complications after laparoscopic bowel resection for endometriosis. Design Retrospective study using data prospectively recorded in the CIRENDO database. Setting University tertiary referral centre. Population Three hundred and three women managed by segmental resection or disc excision for colorectal endometriosis in 40 consecutive months. Methods C-reactive protein was routinely measured at postoperative days 4, 5, and 6. Bowel fistula, pelvic abscess, and pelvic infected haematoma were prospectively recorded. Main outcome measures A receiver operating characteristic (ROC) curve was built to assess the best cut off CRP value to predict early septic complications. Results The incidence of bowel fistula and pelvic abscess/infected hematoma were 2 and 7.9%, respectively. The CRP cut-off value of 100 mg/l at postoperative day 4 predicts early septic pelvic complications (sensitivity, specificity, positive and negative predictive values of, respectively, 76, 83, 30.2, and 90.4%), and the area under the curve was 0.85 (95% CI 0.78-0.92). Conclusion Postoperative CRP monitoring is useful in the prediction of early septic pelvic complications following bowel endometriosis surgery, with possible impact on the management of postoperative outcomes and hospitalisation stay. Tweetable abstract Levels of CRP ≥100 mg/l at day 4 after bowel resection or excision for endometriosis are associated with early septic pelvic complications.

AIM: It is well established that ileo-anal pouch-related septic complications (PRSC) increase the risk of pouch failure. There are a number of publications that describe the management of early PRSC in ulcerative colitis (UC) in small series. This article aims to systematically review and summarize the relevant current data on this subject and provide an algorithm for the management of early PRSC. METHOD: A systematic review was undertaken in accordance with PRISMA guidelines. Studies published between 2000 and 2017 describing the clinical management of PRSC in patients with UC within 30 days of primary ileo-anal pouch surgery were included. A qualitative analysis was undertaken due to the heterogeneity and quality of studies included. RESULTS: A total of 1157 abstracts and 266 full text articles were screened. Twelve studies were included for analysis involving a total of 207 patients. The studies described a range of techniques including image-guided, endoscopic, surgical and endocavitational vacuum methods. Based on the evidence from these studies, an algorithm was created to guide the management of early PRSC. CONCLUSION: The results of this review suggest that although successful salvage of early PRSC is improving there is little information available relating to methods of salvage and outcomes. Novel techniques may offer an increased chance of salvage but comparative studies with longer follow-up are required.

Background The feasibility, safety and outcomes of robotic presacral neurectomy were evaluated. Methods A retrospective analysis was performed of 33 patients with midline chronic pelvic pain, who underwent robotic presacral neurectomy. Data were collected during the period March 2004–March 2010. Results All patients underwent robotic presacral neurectomy and additional robotic procedures. Mean operating time for robotic presacral neurectomy was 5.8 (range 4.4–6.9) min. Mean blood loss, including concomitant procedures, was 39 (range 15–150) ml. Most patients were discharged the same day (60%) and mean hospital stay was 0.39 (range 0–2) days. There were no conversions or intra-operative complications. There were two postoperative complications: one pelvic abscess and one Clostridium difficile colitis. Pain improvement was reported by 73% (22/30) of patients. Conclusion Robotic presacral neurectomy is safe and feasible, resulting in improvement of pelvic pain in selected patients. Copyright © 2011 John Wiley & Sons, Ltd.

We performed laparoscopic appendectomy and drainage to treat panperitonitis due to perforated appendicitis that occurred in a 28-year-old woman. We believe this is an appropriate procedure to treat perforated appendicitis because it is safe and minimally invasive, and faster recovery can be expected than after conventional open appendectomy.

Objective: To assess the utility of a less invasive approach to the care of women with a pelvic abscess, we retrospectively reviewed the outcome of women with pelvic abscesses managed by transvaginal ultrasound-guided aspiration.Methods: A retrospective analysis of 27 pelvic abscesses in 22 consecutive women undergoing transvaginal drainage, including 13 tuboovarian abscesses (TOAs) and 14 postoperative abscesses (POAs). All patients received broad-spectrum intravenous antibiotics from the time infection was diagnosed to resolution of signs and symptoms. Chart review and examination of ultrasound files were utilized to extract demographic clinical, laboratory, and outcome data.Results: The mean age for the study group was 30 years old. Mean duration from diagnosis to drainage was 5.6 days (TOA) and 2.0 days (POA), P < 0.01. The mean diameter of the abscesses was 86 mm. The volume of purulent material drained ranged from 70–750 mL. Perceived adequacy of drainage was correlated with lack of abscess septation. Cultures for aerobic and anaerobic pathogens were positive in 51% of cases (79% POA versus 23% TOA, P < 0.05) with 1.9 organisms/ positive culture. Transvaginal drainage was successful in 25 of 27 abscesses. No complications were reported.Conclusion: In skilled hands, transvaginal guided aspiration of pelvic abscess is a highly successful technique with minimal risk to the patient. Follow-up studies are needed to assess the long-term sequelae, such as frequency of infertility, ectopic pregnancy, and chronic pelvic pain. Infect. Dis. Obstet. Gynecol. 7:216–221, 1999.

This report describes the use of an Argyle trocar catheter for the drainage of pelvic abscesses following transvaginal ultrasound-directed follicle aspiration (UDFA) for oocyte collection. Three patients treated with this technique recovered uneventfully. We conclude that the use of an Argyle trocar catheter for colpotomy in the management of pelvic abscesses appears to be simple and effective.

A pelvic abscess occurred in an infertile woman with an endocervical gonococcal infection after hysterosalpingographical examination. The pelvic abscess was not cured despite rigorous antimicrobial chemotherapy until two intra-abscess ceftriaxone injections were administered. This shows that antibiotics administered systemically may not reach therapeutic concentration in an abscess and an intra-abscess antibiotic injection may help to cure it.

EDITORIAL COMMENT": We accepted this case for publication to inform readers of the possibility of a pelvic abscess occurring associated with a clip on the Fallopian tube. A case of multiple pelvic abscesses due to actinomycosis was recently reported in this journal (A) that showed some similarities to the case here described. It is agreed that pelvic abscesses associated with a foreign body require removal of the foreign body but the reviewer of this paper also cautioned that recurrent pelvic abscesses may cause chronic pelvic inflammatory disease which requires further surgery such as hysterectomy and salpingo-oophorectomy. It is too early to conclude that this woman is cured of the pelvic infection. (A) Garland SM, Rawling D. Pelvic actinomycosis in association with an intrauterine device. Aust NZ J Obstet Gynaecol 1993; 33: 96–98.

may be pervasive within this context. STI risks unique to sex trafficking have been well-articulated in other settings [3]. The present study concerning disempowerment-related STI/HIV vulnerabilities among prostituted women in Nicaragua identified extensive experiences of trafficking, as well as violence and powerrelated barriers to condom use. Findings strongly indicate the need for further efforts to evaluate and address these forms of disempowerment and their implications for STI/HIV risk among prostituted women in the region.

The recent incidence of acute-on-chronic pelvic inflammatory disease, with associated abscess formation, has dramatically increased. Recurrent abscess formation in chronic pelvic inflammatory disease that fails to respond to maximal antibiotic treatment has been traditionally treated by open surgical drainage, frequently accompanied by pelvic clearance. With the development of techniques associated with in vitro fertilization, treatment can now be effected allowing conservation of fertility. This paper describes 12 cases of ultrasound-directed transvaginal fine-needle aspiration of pelvic abscess. A positive outcome occurred in all patients, thus avoiding major surgery. Copyright © 1991 International Society of Ultrasound in Obstetrics and Gynecology

Retrospectively the records of 155 patients with an acute pelvic abscess who were treated by colpotomy drainage were studied. The more aggressive management, i.e. surgery, is to be preferred and the vaginal approach gives good results. The complications and morbidity in this series were very low and the mortality less than 1%. The procedure itself is simple and requires no special skill or great experience.

Pelvic abscess is a relatively uncommon condition in current surgical practice. However, candidates for higher surgical degrees have shown an inadequate knowledge of the management of the various types of pelvic abscess. This observation includes candidates confining their activities to the surgical aspects of gynaecology. It is considered, therefore, that a contribution on the subject of the management of pelvic abscess is justifiable.

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