Pelvic effusion

There are two types of patients with pelvic effusion. One type is that the patients themselves magnify some minor problems, seek medical treatment in many hospitals, and undergo repeated examinations. They hold a thick stack of medical records, various tests, and various examinations in their hands, and then talk to you about their various discomforts. However, when you look through the previous tests and physical examinations, you often find that the patient is very healthy. The other type is passive over-examination and treatment. The patient went to some informal hospitals just because of one problem, and the doctor found other "major" problems after a series of tests. The original problem was not solved, but thousands of yuan were spent on the new "major problem". When the money was spent, it suddenly dawned on them that they should go to a formal hospital for re-examination and treatment, and found that the patient had been led astray, and the problem that the patient originally sought medical treatment for was not solved.

Today, let’s talk about the chaotic pelvic effusion.

Pelvic effusion is an ultrasound diagnosis. A small amount of effusion cannot be diagnosed clinically and can only be diagnosed through ultrasound examination. When patients in the obstetrics and gynecology department undergo pelvic ultrasound, the following words often appear: a small amount of pelvic effusion.

Many patients get very nervous when seeing this diagnosis, and some doctors will label patients as having chronic pelvic effusion because of a small amount of pelvic effusion. And patients are like landlords who can never take off their hats. When they see a doctor, they will say that they have suffered from chronic pelvic effusion and adnexitis. And they may have taken various anti-uterine inflammation tablets, gynecological Qianjin tablets, Chinese medicine enema, etc. for a long time.

These Chinese patent medicines can neither treat gynecological inflammation nor eliminate small amounts of pelvic fluid that is not caused by inflammation.

First, let's understand how pelvic effusion is produced. Our pelvic cavity and abdominal cavity are connected. The abdominal cavity contains organs such as the liver, spleen, intestines, and greater omentum, and the pelvic cavity contains organs such as the uterus, ovaries, bladder, and rectum. The surface of the organs is covered with peritoneum, which forms a closed cavity with the peritoneum of the abdominal wall. This cavity certainly cannot be dry. If it is dry, how painful it would be when the intestines move. These fluids are produced by the peritoneum and are also absorbed by the peritoneum. They are continuously produced and absorbed to maintain balance. Sometimes there is a little more, and effusion will form in the Douglas fossa, the lowest point of the pelvic cavity. In addition, the outflow of follicular fluid during female ovarian ovulation and the reflux of menstrual blood to the pelvic cavity during menstruation will show a small amount of pelvic effusion under ultrasound. These effusions are physiological and do not require treatment.

If the patient has internal or external diseases and some gynecological diseases, the ascites will increase significantly and will extend beyond the pelvic cavity into the abdominal cavity, which we call ascites.

Pelvic effusion and abdominal effusion are examined and diagnosed by ultrasound. When the amount is large, it can be detected by physical examination and percussion. When the amount of ascites is larger, the abdomen will swell. Ultrasound can distinguish whether it is liquid, but it takes some effort to distinguish whether the effusion is blood, pus, or inflammatory exudate or transudate.

If there is a lot of fluid accumulation or is accompanied by other symptoms, then you should consider internal medicine, surgery, or gynecological diseases.

What diseases can cause pelvic effusion or even ascites?

Let's talk about gynecological diseases first. The first thing to think of is ectopic pregnancy and corpus luteum rupture. Ectopic pregnancy and corpus luteum rupture are hemorrhagic diseases. Ectopic pregnancy generally refers to tubal rupture or miscarriage caused by tubal pregnancy, leading to bleeding. The miscarriage type has less bleeding and less fluid accumulation. The rupture type has more bleeding, and the pelvic fluid accumulation will increase, even reaching the abdominal cavity. A large amount of bleeding will cause the patient to suffer from hemorrhagic shock. The most prominent symptom of ectopic pregnancy is a positive urine pregnancy test, accompanied by sudden lower abdominal pain. In addition to seeing pelvic fluid accumulation, ultrasound may also show a mass in the adnexal area. Ectopic pregnancy is a gynecological emergency and requires surgical treatment in most cases.

Corpus luteum rupture is the corpus luteum tissue formed after ovulation. It is relatively fragile and rich in blood vessels. Sexual intercourse during the luteal phase can occasionally cause corpus luteum rupture and bleeding. The amount of bleeding is generally less than that of ectopic pregnancy. There are more opportunities for conservative treatment.

Surgical diseases. Rupture of organs, such as liver and spleen, will manifest as intra-abdominal bleeding, but there will be a history of trauma and upper abdominal pain. Rupture of hollow organs, such as the stomach, intestines, bladder, etc., will cause digestive juices and urine to enter the abdominal cavity, which will also manifest as pelvic and abdominal effusion, but due to strong chemical stimulation, there will be severe peritonitis symptoms.

Ovarian tumors. Malignant ovarian tumors are often accompanied by ascites. Sometimes ascites is the first symptom. There will be a large number of cancer cells in the ascites. Malignant ovarian tumors with ascites will increase the tumor stage.

Liver disease. Liver diseases such as cirrhosis and liver cancer usually cause dysfunction of liver protein synthesis, resulting in hypoproteinemia. Hypoproteinemia causes the colloidal osmotic pressure of the blood to be too low, causing a large amount of fluid to leak out of the peritoneal cavity, forming ascites.

Kidney disease. Some kidney diseases can cause proteinuria and ascites due to hypoproteinemia.

Whether it is caused by liver or kidney disease, hypoproteinemic ascites may be accompanied by pleural effusion, pericardial effusion, lower limb edema, eyelid edema, etc. Of course, liver and kidney function, liver and spleen ultrasound, etc. may also reveal abnormalities.

Tuberculous peritonitis. Currently, tuberculosis infection is on the rise again. Intestinal tuberculosis and tuberculous peritonitis often lead to large amounts of ascites and intestinal adhesions. In the early stages, ascites is the main symptom, and in the later stages, ascites decreases and intestinal adhesions occur. Tuberculosis infection often presents with low-grade fever and night sweats, and in the late stages, there will be intestinal obstruction. However, in the earliest stages, when the symptoms are atypical, there may only be a small amount of pelvic effusion.

The above are some of the diseases that may cause a large amount of pelvic and abdominal fluid. Next, let’s talk about the diseases that are often diagnosed due to a small amount of pelvic fluid.

Pelvic effusion disease refers to acute upper reproductive tract infection caused by pathogens such as aerobic bacteria, anaerobic bacteria, mycoplasma, chlamydia, etc. It includes endometritis, salpingitis, tubo-ovarian abscess and pelvic peritonitis.

Patients usually have symptoms of abdominal pain and fever. During gynecological examination, there should be uterine tenderness, adnexal tenderness, and cervical lifting pain. The "three pains" of gynecological examination are the minimum diagnostic criteria. If there are combined symptoms such as increased body temperature, purulent cervical secretions, and culture of pathogens, it can support the diagnosis of pelvic effusion. If endometrial biopsy pathology confirms the presence of endometritis, vaginal ultrasound, MRI shows thickening of the fallopian tube wall, effusion in the tubal cavity, accompanied by a small amount of pelvic effusion, fallopian tube and ovarian mass or laparoscopic surgery, the diagnosis can be confirmed.

In summary, the diagnosis of pelvic effusion requires the presence of pelvic pain symptoms, infection pathogens, and systemic manifestations caused by bacterial infection. The most important thing to confirm the diagnosis is the pathology and imaging changes of the pelvic organs. Simple asymptomatic, small amounts of pelvic effusion cannot be diagnosed as pelvic effusion.

Let's talk about the so-called "chronic pelvic effusion". Why do I put it in quotation marks? Because this diagnostic term is no longer included in the "Guidelines for the Diagnosis and Treatment of Pelvic Effusion Diseases (Revised Edition)".

"Chronic pelvic effusion" is a major area of ​​overdiagnosis and treatment in gynecology. Doctors often diagnose a patient with chronic pelvic effusion when a small amount of pelvic effusion is found or the patient complains of abdominal pain. The patient is then given various antibiotics, Chinese patent medicines, enemas, flushing, and infrared therapy.

After the pelvic effusion disease is cured, will it become chronic pelvic effusion for a long time? After the pelvic organ infection, after antibiotics and surgical treatment, bacteria, chlamydia, and other pathogens are removed, the pain symptoms disappear, the body temperature will drop, the white blood cells will drop, and the pus in the pelvis will be absorbed, which means it is cured. However, if the infection is serious, the damage to the organ caused by the original pathogen infection may exist for a long time after the cure. The most serious manifestations are adhesion and blockage of the fallopian tube fimbria, twisted fallopian tubes, and adhesions of the fallopian tubes to the ovaries. Sometimes, fluid accumulation in the fallopian tubes occurs. These changes have little effect on health, but they will seriously affect fertility and lead to tubal infertility. It is one of the main causes of female infertility. Sometimes, unobstructed fallopian tubes are also prone to ectopic pregnancy.

Adhesion and blockage of the fallopian tube is the consequence of fallopian tube inflammation. Some mild and atypical fallopian tube inflammation, without obvious abdominal pain, fever, etc., can still cause adhesion and blockage of the fallopian tube.

Pelvic adhesions, fallopian tube distortion, and obstruction after acute pelvic effusion are not chronic pelvic effusion because they do not have the elements of inflammation: degeneration, exudation, and hyperplasia, nor do they have the elements of infection: infection by pathogens. Therefore, there is no need for anti-infection and anti-inflammatory treatment.