How to diagnose pelvic effusion in the early stage

For patients with a history of acute pelvic effusion and symptoms and signs, the diagnosis is usually not difficult. However, sometimes patients have more symptoms but no obvious history of pelvic effusion and positive signs. At this time, the diagnosis of chronic pelvic effusion must be cautious to avoid making a rash diagnosis and causing mental burden on patients. Sometimes pelvic congestion or varicose veins in the broad ligament can also produce symptoms similar to chronic inflammation. Pelvic effusion should undergo necessary blood and urine routine and cervical canal secretion culture and drug sensitivity tests. If necessary, a posterior fornix puncture can be performed, and the diagnosis can be confirmed if pus is extracted. The culture results of pelvic pus can determine the pathogen.

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. 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.

2. Pathogen culture

The specimens are from the same source as above. They should be inoculated on Thayer-Martin medium immediately or within 30 seconds and cultured in a 35°C incubator for 48 hours. The bacteria are identified by glycolysis. The new relatively fast chlamydial enzyme assay replaces the traditional chlamydia detection method. The chlamydia trachomatis antigen detection can also be performed using mammalian cell culture. This method is an enzyme-linked immunosorbent assay. The average sensitivity is 89.4%, with a specificity of 98.4%.

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 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.

4. Ultrasound examination

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

6. Examination of male partners

This helps in the diagnosis of female pelvic effusion. The urethral secretions of the male partner can be directly smeared or cultured for gonorrhea. If positive, it is a strong evidence, especially in those who are asymptomatic or have 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.