How to differentiate acute pelvic peritonitis

How to make a differential diagnosis of acute pelvic peritonitis? This is a question that many patients are concerned about. According to experts, it is not difficult to make a diagnosis based on medical history, symptoms and signs, but it should be distinguished from acute appendicitis perforation. The following is a detailed description of the differential diagnosis of acute pelvic peritonitis.

(I) Direct smear sampling of secretions can be vaginal, cervical, 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 stain. Anyone who sees Gram-negative diplococci in polymorphonuclear leukocytes is infected with gonorrhea. Because the detection rate of cervical gonorrhea is only 67%, a negative smear cannot exclude the presence of gonorrhea, and a positive smear is very specific. Fluorescein monoclonal antibody dye can be used for microscopic examination of Chlamydia trachomatis. Any star-shaped flashing fluorescent dots observed under a fluorescence microscope are positive.

(II) The source of pathogen culture specimens is the same as above. They should be inoculated on Thayer-Martin medium immediately or within 30 seconds, and cultured in a 35℃ incubator for 48 hours. Bacterial identification is performed by glycolysis. The new relatively rapid chlamydial enzyme assay replaces the traditional chlamydia detection method. Mammalian cell culture can also be used to detect Chlamydia trachomatis antigens. This method is an enzyme-linked immunosorbent assay. The average sensitivity is 89.5% and the specificity is 98.4%.

Bacteriological culture can also obtain other aerobic and anaerobic strains and serve as a basis for selecting antibiotics.

(III) Posterior fornix puncture Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. Through puncture, the contents of the abdominal cavity or the rectouterine fossa, 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.

(IV) Ultrasound examination mainly includes B-type 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, it is difficult to show the characteristics of mild or moderate pelvic inflammatory disease in B-type ultrasound images.

(V) If the patient is not suffering from diffuse peritonitis and is in good general condition, laparoscopy can be performed on patients with pelvic inflammatory disease, suspected pelvic inflammatory disease, or other acute abdominal diseases. Laparoscopy can not only confirm the diagnosis and differential diagnosis, but also make a preliminary assessment of the severity of pelvic inflammatory disease.

(VI) Examination of male partners This is helpful for the diagnosis of female pelvic inflammatory disease. The urethral secretions of the male partner can be directly smeared or cultured for gonorrhea. If positive, it is a strong evidence, especially in patients with no symptoms or mild symptoms. Or more white blood cells can be found. If all male partners of PID patients are treated, regardless of whether they have symptoms of urethritis, it is obviously very meaningful to reduce recurrence.