Pediatric emergency medicine trisk 2137 2137
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antibiotic treatment of those patients at highest risk of subsequent ectopic
pregnancy and infertility ( Fig. 92.3 ).
A complication of PID that warrants prompt diagnosis is ruptured tuboovarian
abscess. About 15% of tuboovarian abscesses rupture spontaneously. The
symptoms and signs of a ruptured abscess may be mild if only a small amount of
pus has leaked out, but the usual clinical picture includes peritonitis and shock. A
pelvic mass is palpable in less than one-half the cases. Prompt surgical
intervention can be lifesaving.
Perihepatitis (Fitz-Hugh–Curtis syndrome), consisting of right upper quadrant
pain and tenderness produced by inflammation of the liver capsule in association
with PID, occurs in 4% to 30% of cases of PID and is more likely to occur with
gonococcal infection and more severe diseases. On transvaginal ultrasonography,
about one-third of patients with PID will have visible fallopian tubes and about
one-fifth will have a demonstrable tuboovarian abscess ( Fig. 92.4 ).
Laparoscopy confirms the diagnosis of PID in only about 60% of patients who
are suspected, either by gynecologists or by primary care physicians, on clinical
grounds of having the disease. Conditions most often mistaken for PID are acute
appendicitis, endometriosis, hemorrhagic and nonhemorrhagic ovarian cysts, and
ectopic pregnancy. In up to 25% of women judged clinically to have PID, no
abnormality can be identified laparoscopically.
