Pyosalpinx

Specialty: Gynecology and breast.

• Purulent fallopian tube
• tubal abscess
• collection of pus in the tube

Why it occurs

• Acute progression of Pelvic Inflammatory Disease (PID) with accumulation of purulent exudate at high pressure inside the fallopian tube that is occluded at its distal end by previous inflammatory adhesions, usually secondary to ascending infections by Neisseria gonorrhoeae, Chlamydia trachomatis or mixed vaginal bacterial flora

Initial workup

Urgent transvaginal gynecological ultrasound (a dilated tubular structure is observed, with thickened walls >5 mm, filled with dense echogenic fluid with debris inside and marked hyperemia of the wall using color Doppler, associated with purulent free fluid in the pelvis). Complete blood count with urgent formula, CRP and procalcitonin. Cervical exudate culture for Chlamydia and Gonococcus by PCR, blood cultures if bacteremia is suspected.

Standard management

• Ceftriaxone 1-2 g intravenously every 24 hours associated with Doxycycline 100 mg every 12 hours intravenously or orally, plus Metronidazole 500 mg every 8 hours intravenously for a period of 10-14 days — standard hospital guideline for pelvic abscesses
• Clindamycin 900 mg intravenously every 8 hours associated with Gentamicin 3-5 mg/kg/day intravenously as an alternative. If there is no evident clinical improvement after 48-72 hours of optimal intravenous antibiotic therapy, or if there are signs of imminent rupture, laparoscopic drainage with salpingectomy or transvaginal ultrasound-guided drainage is required (note: initial hospital management with monitoring of vital signs is mandatory).