rforation of the bowel from inflammatory bowel conditions such as Crohn's disease can cause pelvic adhesions and damage the reproductive tract of females. A tubo-ovarian mass may develop. IUDs may become infected with Actinomyces israelii and cause PID and pelvic abscesses.
Signs and symptoms of PID include pyrexia over 38C, malaise, lower abdominal pain, abnormal vaginal or cervical discharge, cervical excitation ad adnexal tenderness, intermenstrual bleeding, deep dyspareunia and abdominal bloating (Clinical). Diagnosis includes a full blood count, urea and electrolytes, C-reactive protein and ESR. Transvaginal ultrasound scanning, Doppler blood studies and MRI scans are also useful. Pelvic ultrasound can detect an abscess, ovarian cysts and hydrosalpinges, and free fluid within the pouch of Douglas and pelvis. Laparoscopic diagnosis may be necessary, though in 30 percent of cases, this misses infections. It does show adhesions to the liver and abdominal wall, termed the Fitz-Hugh-Curtis syndrome. Patients with acute PID need to be hospitalized, treated with antibiotics (metronidazole and doxycycline), and rehydrated. The most serious complications of PID are tubal damage and infertility, as well as chronic vaginal discharge and recurrent infections.
PID can be seen ultrasonically in many different ways, including thickening of the tubal wall, incomplete septa within a dilated tube, hyperechoic mural nodules or free fluid in the cul-de-sac (Kupesic and Aksamija). Intracystic echoes depend on the quality and quantity of blood clots, so hemorrhagic ovarian cysts will give a variety of ultrasound findings. Most patients with endometriosis show an endometrioma containing diffuse 'carpet like' echoes. Detection of pericystic and/or hilar ovarian endometrioma vascularization by Doppler color ultrasound facilitates correct recognition of this condition. Color Doppler also demonstrates a moderate to low vascular resistanc...