When is the likelihood of developing a Douglas pouch abscess increased?

There is a space between the uterus and the rectum in women called the pouch of Douglas. This is the cavity of the small pelvis, covered with the peritoneum. This anatomical formation is important because it often develops an inflammatory process of a purulent nature, which requires surgical intervention. What causes a Douglas pouch abscess?

Causes and mechanism of Douglas pouch abscess formation

The formation of an abscess in the pelvis is always secondary. Often, an abscess of the Douglas space is formed against the background of destructive acute appendicitis, if the appendix is ​​located in the pelvis. Purulent diseases of the appendages can also provoke the development of an abscess. Perforation of the colon with the development of peritonitis can also lead to the development of an abscess of the Douglas pouch.

Due to anatomical features, blood, serous or purulent effusion flows into the space between the uterus and rectum, mesenteric sinuses and canals also open into the space. During surgery, in case of insufficient revision of the postoperative wound, as well as poor drainage and sanitation of the small pelvis, conditions are created for the development of purulent inflammation of the Douglas space.

The pyogenic microflora of the Douglas pouch abscess is represented by non-specific pathogens:

• E. coli;
• staphylococci;
• streptococci;
• Pseudomonas aeruginosa.

Symptoms of abscess formation in the pouch of Douglas

As a rule, an abscess of the Douglas space begins to form a few days after surgery due to the primary purulent pathology of the small pelvis. The clinical picture begins with the development of nonspecific symptoms - fever, sudden chills, headache, nausea and tachycardia. In addition, a woman feels pain, heaviness and a feeling of fullness in the lower abdomen, which become more intense with movements and physiological functions.

Urination may be painful and frequent, and stools may be watery with blood and mucus mixed in. There are also phenomena of incontinence of gases and stool, tenesmus. If the abscess is large and massive, it can compress the rectum and provoke intestinal obstruction. If the abscess is not identified and eliminated in time, it can break into the abdominal cavity. Prolonged course of an abscess of the Douglas space leads to the development of thrombophlebitis of the veins of the pelvis and the development of thromboembolic disease.

Diagnostic aspects of Douglas pouch abscess

When diagnosing, an anamnesis is collected, in which recent diseases and operations are revealed, on the basis of which a Douglas pouch abscess can be suspected. During palpation, pain in the projection of the small pelvis is determined, there is a defense, the Shchetkin-Blumberg symptom is positive. Vaginal or rectal palpation reveals a painful stiff elastic infiltrate, in the center of which there is softening and fluctuation.

Palpation of the Douglas space in women is possible above the cervix, and an overhang of the posterior fornix is ​​also detected. Differential diagnosis of an abscess of the Douglas space is carried out with a tubovarial abscess. For this, a pelvic ultrasound is performed. To confirm the diagnosis of an abscess in controversial cases, an abscess is punctured under ultrasound control through the rectum or posterior vaginal fornix.

How is a Douglas pouch abscess treated?

At the stage of infiltration, microclysters are performed against the background of antibiotic therapy. When the abscess is finally formed, as evidenced by the softening of the infiltrate, the abscess is opened. The abscess is opened through the posterior fornix of the vagina or the wall of the rectum. Before opening, a puncture is performed with a thick needle. Upon receipt of pus, the hole along the needle is dissected for its free outflow, drainage is installed in the hole in the needle. Be sure to sanitize the purulent cavity.

Thus, if women complain of weakness, fever and pain in the lower abdomen after surgery on the pelvic organs, it is necessary to think about the possibility of developing an abscess of the Douglas pouch. After operations on the pelvic organs, a woman needs to be monitored for two weeks to prevent the possible development of a purulent complication.

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