How to Differentiate and Diagnose Pelvic Peritonitis

When there is a serious infection in the pelvic organs, the pathogens can spread through the blood or lymphatic system or directly spread to the pelvic peritonitis, which is called pelvic peritonitis. Pelvic peritonitis often coexists with other pelvic infections, especially salpingitis. The main clinical manifestations are lower abdominal pain and fever. Pelvic peritonitis can be divided into common purulent peritonitis and gonococcal peritonitis according to the type of pathogenic bacteria. So how should pelvic peritonitis be differentiated and diagnosed?

1. Acute appendicitis perforation: Acute appendicitis usually has no history of pelvic infection, and the most common course of onset is right lower abdominal pain. Fever often occurs after abdominal pain, and the pain is most obvious at McBurney's point. The psoas major and colon inflation tests are positive. After perforation, abdominal muscle tension and rebound pain are the main signs. Rectal digital examination has tenderness on the right side, and gynecological examinations usually show no abnormalities.

2. Ruptured ectopic pregnancy or secondary infection: Ruptured ectopic pregnancy is often accompanied by a history of amenorrhea and irregular vaginal bleeding, characterized by sudden onset of abdominal pain accompanied by shock and acute anemia, and usually without fever. The diagnosis can be confirmed by puncturing the posterior fornix and drawing out non-clotting blood. Secondary infection is often seen in the infection of hematoma of abortion-type bleeding, with a history of transient abdominal pain or syncope, manifested as high fever, abdominal pain, and abdominal distension. At this time, bimanual examination is often unsatisfactory. Puncture of the posterior fornix can sometimes draw out old blood and small blood clots.

3. Intestinal perforation: Intestinal perforation is characterized by sudden severe abdominal pain, boat-shaped abdomen, obvious tenderness and rebound pain in the abdomen, rigidity of the rectus abdominis, shrinkage or disappearance of the liver dullness area, disappearance of bowel sounds, and mobile dullness in severe cases. Abdominal puncture or posterior fornix puncture to extract intestinal contents can confirm the diagnosis. X-ray examination shows free gas under the intestine.

4. Ovarian cyst pedicle torsion or rupture: This disease often has a history of pelvic mass, with sudden persistent pain on one side of the lower abdomen, like strangulation, accompanied by nausea and vomiting. Abdominal examination shows tenderness on the affected side, obvious rebound pain, and no obvious muscle tension. During gynecological examination, a mass on one side of the pelvis can be palpated, which is tender, and the tenderness is more obvious at the uterine angle on the affected side. If the cyst ruptures, persistent abdominal pain may be accompanied by fever, abdominal muscle tension or mobile dullness, and even shock of varying degrees. Gynecological examination can find that the original pelvic mass has been significantly reduced, with unclear boundaries or disappearance.