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Abstract: Xiao Huang underwent tubal lavage surgery to prepare for her second child. After the surgery, she had frequent sexual intercourse prematurely, followed by menstruation, and the dilated uterus and decreased immunity during menstruation caused vaginal pathogenic bacteria to travel up to the uterus and pelvis, resulting in pelvic inflammatory disease and lower abdominal cramps and fever. She was diagnosed with pelvic inflammatory disease and vaginitis. She was given intravenous anti-inflammatory drugs, vaginal plugs and douches, and had good results with symptomatic treatment.
Basic information】Female, 33 years old
Disease Type】Pelvic inflammatory disease, vaginitis, pelvic effusion
Hospital】Guangxi Zhuang Autonomous Region Jiangbin Hospital
Time of consultation】May 2022
Treatment plan】Medication (Ceftriaxone sodium for injection + 0.9% sodium chloride solution + metronidazole injection + compound metronidazole vaginal pessary + maternal health lotion)
Treatment period】7 days in hospital, 1 week after outpatient review
Treatment effect】The condition was controlled, the fever and lower abdominal cramps were relieved, and all indicators were improved.
I. Initial consultation
The patient reported that she had a tubal lavage on April 12, 2022 because she had not conceived for nearly one year and started to have sexual intercourse one week after the operation, and then she had sexual intercourse several times. On May 11, the pain in the lower abdomen became obvious, and she developed fever and her temperature reached 38℃. After disinfection, she underwent gynecological examination and was diagnosed with pelvic inflammatory disease.
II. Treatment history
After admission, routine blood tests, leukocyte examination and ultrasound examination were completed, including routine blood test results of 15.74×10^9/L, 86.2% neutrophil percentage, leukocyte examination results of leukocyte cleanliness degree IV, trichomonas (+), ultrasound results of pelvic effusion 36×13mm, no obvious abnormalities in the uterus and bilateral adnexa, and no obvious abnormalities in the rest. The doctor explained to the patient that pelvic effusion, uterine pressure and abdominal pain were clinical manifestations of pelvic inflammatory disease. The cause of pelvic inflammatory disease was considered to be vaginitis caused by premature and frequent sexual intercourse after tubal lavage, while pathogenic bacteria in the vagina during menstruation could easily enter the uterus and pelvis and lead to pelvic inflammatory disease. The patient expressed understanding and cooperated with the treatment. Immediately after admission, she was given Ceftriaxone sodium for injection + 0.9% sodium chloride solution, metronidazole injection for anti-inflammatory treatment, compound metronidazole vaginal pessary and maternal health wash for douching.
III. Treatment effect
After 2 days of treatment, the patient’s body temperature returned to normal, the abdominal pain was reduced, and the vaginal odor disappeared. After 5 days of treatment, the routine blood test showed that the white blood cells were 9.35×10^9/L and the percentage of neutrophils was 76.2%, indicating that the treatment was effective. After 7 days of treatment, the patient’s vital signs were normal, the lower abdominal cramps disappeared, and there was no obvious pressure pain in the uterus and adnexal area on gynecological examination, and the repeat ultrasound indicated that no pelvic fluid was seen.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to remind the patient to pay attention to some matters in daily life.
1. It is suggested that the patient should go to the outpatient clinic after 1 week to review the leucorrhoea examination and blood routine, and wait for the inflammation to be completely cured before having intercourse to avoid recurrent attacks.
2. Patients are advised to pay attention to improving body resistance and immunity, such as exercising properly, not staying up late, not overworking, ensuring good sleep quality, eating more fresh fruits and vegetables, etc.
4. If the patient plans to have another pregnancy, it is recommended that both spouses should do a good pre-conception examination.
V. Personal insight
By understanding the patient’s situation in this case, we reminded the patient that after performing tubal lavage, abortion, diagnostic scraping and other uterine operations, she should not only pay attention to avoid premature sexual intercourse, but also pay attention to good hygiene habits to avoid infection. Because most patients have pelvic infections from vaginitis upstream, early treatment should be carried out when vaginitis appears, which can avoid the development of pelvic inflammatory disease and complications such as pelvic effusion, pelvic pain and infertility caused by pelvic inflammatory disease. Inflammatory exudate accumulates in the posterior fornix after pelvic effusion, which can easily cause lower abdominal cramps. Early medical consultation and treatment should be provided for better results when such symptoms appear.