PID

By Tedler D. Depaynos, MD

The patient is a 32 yrs old female who came in because of on and off “severe” abdominal pain which started 3 weeks ago. She described the pain to be sometimes 11/10 lasting for 8 to 10 hours. She claims to have no problem in urination or moving her bowels. Because the pain on occasion becomes tolerable and she was afraid to be operated on she delayed her going to the hospital. When she could no longer bear the pain for hours, had fever and could not even stand up, she finally consented to be brought to the hospital.
The pain was more localized at the left lower abdomen and because of the severity and was on and off, the initial impression was probably a stone in the left ureter. In general, pain emanating from a moving stone is severe and when it stops moving, relief occurs. An emergency abdominal ultrasound (UTZ) concentrating more on the pelvic organs and kidneys to the bladder was then done to try to confirm the impression. The result, however, was not significant. On closer examination, there was slight rigidity on the painful left area compared to the right and the patient claimed to have vaginal discharges from time to time. She was then referred to an OB-Gyn MD who did an internal and more precise examination. The impression was then changed to Pelvic Inflammatory Disease or PID.
PID is inflammation of the genital female organs mostly due to infection. The infection may arise from the vagina causing vaginitis and after sometime may extend into the cervix and endometrium causing endometriosis and into the fallopian tubes, salphingitis and also into the ovaries, oophoritis. It may leak into the peritoneal cavity causing inflammation or peritonitis or even abscess formation. When it occurs at the lower right side of the abdomen it may be misdiagnosed as Acute Appendecitis because the results of the abdominal physical examination may be similar.
In some cases, inflammation of the organs may cause it to enlarge like in salphingitis and this could sometimes be appreciated in the UTZ.
The infection of the female genital organs may be due to viruses, fungus or bacteria which could be a mixture of the gram negative and anaerobic ones. In rare cases it may be due to tuberculosis (TB) or even gonorrhea (GC). The incidence is higher in females with multiple sexual partners and it could be transmitted sexually hence, a confidential interview is sometimes done with the partner.
The OB-GYN MD gave massive antibiotics intravenously and the patient was observed for 1 – 2 days. If no improvement would be seen like no decrease in pain or relief from the fever, further work up would be done. A smear to try to identify the organisms causing the infection would be in order. Fortunately, the response of the patient to the treatment was dramatic.
In unfortunate cases where the infection may not be controlled conservatively, surgery may be the end result which the patient was afraid of. An abscess may require drainage and washing of the peritoneal cavity. The worst part is excision of the infected fallopian tube which could be filled with pus. This obviously would result in infertility especially if the other fallopian tube is also involved.
Some younger OB-GYN specialists do laparoscopic surgery and sometimes it is routinely done to confirm the impression.
The patient was then discharged and advised to take her oral medicines for a week or two. Likewise, vaginal hygiene was advised.**