What is pelvic peritonitis?

Pelvic peritonitis is a common gynecological disease, and its clinical features are mainly fever, lower abdominal pain, increased vaginal discharge, and irregular menstruation. Gynecological examinations can show thickening, tenderness, or masses in the vagina and adnexa. This disease mostly occurs in women of childbearing age, and a few occur in unmarried people. Pelvic peritonitis is not recorded in TCM literature. According to its clinical symptoms and signs, it seems to be related to fever during menstruation, vaginal discharge, scars, etc.

【Etiology and pathology】

1. Dampness and toxins accumulate. During menstruation, the organs are weak, and the birth canal is not closed. Dampness and heat invade the lower pelvic cavity, and the toxins accumulate over time, causing illness. It can also be caused by not avoiding sexual intercourse during menstruation, abortion, or gynecological surgery, etc., which are not properly disinfected, and pathogenic bacteria invade the internal reproductive organs and cause illness.

2. Stagnation of Qi and blood stasis, dampness and toxins block the flow, and blood stasis and heat cause scars.

Or depression and anger may cause disorder of Qi and blood stasis which may lead to scar formation.

3. Organ imbalance and excessive fatigue will lead to organ dysfunction, disharmony of qi and blood, which will stagnate and form scars.

【Diagnosis points】

1. Symptoms: fever, lower abdominal pain, yellowish discharge, lumbar pain or soreness.

2. Gynecological examination shows abundant and purulent vaginal discharge, cervical tenderness and congestion, uterine edema and tenderness, thickening of the adnexa on both sides with obvious tenderness, or inflammatory masses.

3. Laboratory examination: Routine blood test shows elevated white blood cells and increased neutrophils. Bacterial culture of uterine secretions may reveal pathogenic bacteria.

4. Ultrasound shows adnexal edema or a mass with unclear boundaries, indicating an inflammatory mass.

The above is the diagnostic basis for acute pelvic peritonitis. If the acute inflammation is not completely cured after treatment, it will develop into chronic pelvic peritonitis. The main symptoms are dull pain in the lower abdomen, frequent white or yellow discharge, low back pain, thickening or tenderness in the adnexal area, or a mass.

【Dialectical classification】

1. Dampness and toxins accumulate and cause fever before and after menstruation, pain in the lower abdomen that refuses to be pressed, yellow or smelly discharge, yellow or red urine, irregular bowel movements, yellow and greasy tongue coating, red tongue, and slippery and rapid pulse.

2. Qi stagnation and blood stasis with pain in the lower abdomen that refuses to be pressed, or with low fever, lumbar pain, dysmenorrhea, premenstrual breast swelling, menstrual disorders, and pelvic masses. The tongue is purple or has petechiae, and the pulse is thin and stringy.

3. Disorder of internal organs Chronic pelvic inflammation lasts for many years, causing sacral and lumbar pain, aggravated by menstruation, fatigue, dizziness, poor appetite and loose stools. Greasy tongue coating, pale purple tongue with petechiae on the edges, and weak pulse.