What are the diagnostic methods for pelvic peritonitis?

Pelvic peritonitis refers to inflammation of the female internal reproductive organs and the surrounding connective tissue and pelvic peritoneum. Pelvic peritonitis can be limited to one site or involve several sites at the same time. The most common are salpingitis and salpingo-oophoritis. According to its course of disease and clinical manifestations, it can be divided into acute and chronic. This inflammation often occurs in sexually active women who are menstruating. Pelvic peritonitis rarely occurs before menarche, after menopause or unmarried people. When pelvic peritonitis occurs, it is often the spread of inflammation in adjacent organs. Next, the editor will introduce to you what are the examination items for pelvic peritonitis?

1. Direct smear of secretions

The samples can be vaginal, cervical secretions, or urethral secretions, or peritoneal fluid (obtained through the posterior fornix, abdominal wall, or through laparoscopy), and direct thin-layer smears are made, which are then dried and stained with methylene blue or Gram. If Gram-negative diplococci are seen in polymorphonuclear leukocytes, it is gonorrhea infection. Because the cervical canal gonorrhea test is performed, a negative smear cannot exclude the presence of gonorrhea, while a positive smear is specific. Fluorescein monoclonal antibody dye can be used for microscopic examination of Chlamydia trachomatis. If a star-shaped flashing fluorescent spot is observed under a fluorescence microscope, it is positive.

2. Pathogen culture

The specimens are from the same source as above and should be inoculated on Thayer-Martin medium immediately or within 30 seconds and cultured in a 35°C incubator for 48 hours for bacterial identification. New relatively rapid chlamydial enzyme assays have replaced traditional chlamydia detection methods. Chlamydia trachomatis antigen detection can also be performed using mammalian cell culture, which is an enzyme-linked immunosorbent assay. Bacteriological culture can also obtain other aerobic and anaerobic strains and serve as a basis for selecting antibiotics.

3. Posterior fornix puncture

Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. Through puncture, the abdominal contents or uterine rectal fossa contents obtained, such as normal peritoneal fluid, blood (fresh, old, clotted blood, etc.), purulent secretions or pus, can further clarify the diagnosis, and microscopic examination and culture of the punctured material are even more necessary.

4. Ultrasound examination

Mainly B-mode or grayscale ultrasound scanning and filming, this technology has an 85% accuracy in identifying masses or abscesses formed by adhesions of the fallopian tubes, ovaries and intestines. However, mild or moderate pelvic peritonitis is difficult to show characteristics in B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis and the patient's general condition is good, laparoscopy can be performed on patients with pelvic peritonitis or suspected pelvic peritonitis and other acute abdomen. Laparoscopy can not only make a clear diagnosis and differential diagnosis, but also make a preliminary judgment on the degree of pelvic peritonitis.

6. Examination of male partners

This helps in the diagnosis of female pelvic peritonitis. The urethral secretions of the male companion can be directly smeared or cultured for gonorrhea. If positive, it is a strong evidence, especially in asymptomatic or mildly symptomatic patients. Or more white blood cells can be found.