Diseases that should be differentiated from acute pelvic inflammatory disease

Acute pelvic inflammatory disease is more common in women who are menstruating and sexually active. The inflammation can be limited to one part or involve several parts at the same time. The most common are salpingitis and salpingo-oophoritis. Simple endometritis or oophoritis are less common. Pelvic inflammatory disease is divided into acute and chronic types.

Acute pelvic inflammatory disease should be differentiated from acute abdomen such as acute appendicitis, aborted or ruptured tubal pregnancy, and torsion or rupture of ovarian cyst pedicle.

1. Acute appendicitis: Right-sided acute salpingo-oophoritis is easily confused with acute appendicitis. Acute appendicitis often has gastrointestinal symptoms before onset, such as nausea, vomiting, diarrhea, etc. Abdominal pain often occurs around the umbilicus and then gradually fixes to the right lower abdomen. The degree of increase in body temperature and white blood cells is not as high as that of acute salpingo-oophoritis. Gynecological examination often shows tenderness in the cervix and tenderness in both adnexa.

2. Torsion of ovarian tumor pedicle: Severe lower abdominal pain often occurs after the activity of the mass or after defecation. After the ovarian tumor is torsion, there is often bleeding in the cyst cavity, the tumor increases, and there is fever. Inquiring about the medical history and B-ultrasound examination are helpful for diagnosis.

3. Ectopic pregnancy or rupture of ovarian corpus luteum cyst: acute lower abdominal pain and intra-abdominal bleeding may occur. The patient is pale and looks sick, and may even go into shock. Dark red, non-coagulated blood can be drawn out by puncturing the posterior vaginal fornix. Ectopic pregnancy may also have a history of amenorrhea and vaginal bleeding. Urine HCG is often positive. Laparoscopy can confirm the diagnosis.