the Risks of Pelvic Inflammatory Disease After Hysteroscopy

Q: the Risks of Pelvic Inflammatory Disease After Hysteroscopy

Hello, the inquirer： Since each patient's condition is different, based on your description of symptoms, it is recommended to follow your doctor's treatment plan and return for a follow-up appointment for the physician to assess whether the treatment is complete and when you can

Is there a risk of peritonitis due to the hysteroscopy procedure after confirming the presence of bacteria?

Hello, Doctor.
I had a termination of pregnancy on November 18th last year due to abnormalities in the 18th chromosome.
Since then, I have been experiencing vaginal inflammation and have been continuously seeing a doctor.
The doctor diagnosed me with pelvic inflammatory disease and treated me for about 10 days, but I still notice clear discharge with a faint odor (not fishy or foul, just a mild scent).
I went to Yonghe Cheng Hsin Hospital for further evaluation, where the doctor performed a Pap smear and bacterial culture, and assessed the recovery of my uterus.
The endometrium is already quite thick, and the doctor suggested administering progesterone, advising me to return within two weeks; otherwise, there could be adhesions from the termination causing amenorrhea.
Since I really want to have a second child and am worried about infertility, I went to National Taiwan University Hospital for a hysteroscopy to check for adhesions.
The doctor had an opening and scheduled the surgery without specifically mentioning the bacterial culture results.
Afterward, when I returned to Cheng Hsin for the results, I found out there was indeed a bacterial infection.
The doctor mentioned that undergoing a hysteroscopy could easily lead to peritonitis.
The doctor performed a vaginal ultrasound but did not provide much information, only stating that the adhesions might recur.
For the bacterial infection, I was prescribed a 7-day course of ampicillin without a follow-up appointment.
My surgery was from January 19 to January 30, and I currently do not have any significant abdominal pain.

I have a few questions:
1.
Is there still a chance that I could develop peritonitis? If so, how should it be checked?
2.
The doctor mentioned that the bacterial culture showed "fecal xx bacteria" (I didn't hear clearly).
The doctor prescribed a 7-day course of ampicillin, but did not instruct me to return for a follow-up.
How can I confirm if the inflammation has resolved? Should I do another bacterial culture?
3.
Am I indeed experiencing pelvic inflammatory disease? Is hospitalization for intravenous antibiotics the fastest treatment method? Are there any side effects?
Thank you for your assistance!

Haiyang, 30~39 year old female. Ask Date: 2017/01/31

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the inquirer: Since each patient's condition is different, based on your description of symptoms, it is recommended to follow your doctor's treatment plan and return for a follow-up appointment for the physician to assess whether the treatment is complete and when you can start planning for pregnancy.
Thank you! (The content on this website is intended to help you understand related causes but cannot replace a face-to-face diagnosis by a physician.
This website is not responsible for the application of the content by the public.
If you have any questions, please consult your physician for further advice.) Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/01/31

More Info

Pelvic inflammatory disease (PID) is a serious condition that can arise from infections in the reproductive organs, including the uterus, fallopian tubes, and ovaries. It can lead to significant complications, including chronic pelvic pain, infertility, and ectopic pregnancy. Your concerns regarding the risks of PID following a hysteroscopy and the subsequent bacterial infection are valid and warrant careful consideration.

1. Risk of Peritonitis: After any surgical procedure, including hysteroscopy, there is a risk of developing peritonitis, especially if there is an existing infection. Peritonitis is an inflammation of the peritoneum, the lining of the abdominal cavity, which can occur if bacteria from the reproductive tract spread to the abdominal cavity. Symptoms may include severe abdominal pain, fever, and a rigid abdomen. If you experience any of these symptoms, it is crucial to seek immediate medical attention. To check for peritonitis, doctors may perform a physical examination, blood tests, and imaging studies such as an ultrasound or CT scan to assess for signs of infection or inflammation.

2. Bacterial Culture and Antibiotic Treatment: The identification of a bacterial infection, particularly with a strain like "fecal bacteria," suggests that there may have been a breach in the normal barriers that prevent such bacteria from entering the reproductive tract. The antibiotic treatment prescribed (in this case, ampicillin) is appropriate for addressing such infections. To confirm that the infection has resolved, follow-up testing, including repeat bacterial cultures, may be necessary. It is also advisable to monitor your symptoms closely; if they persist or worsen, further evaluation is warranted.

3. Understanding PID: Given your history of persistent vaginal inflammation and the recent findings, it is possible that you are experiencing PID. PID can be diagnosed based on clinical symptoms, pelvic examinations, and imaging studies. While outpatient antibiotic therapy is often effective, severe cases may require hospitalization for intravenous antibiotics. The decision to admit a patient for treatment depends on the severity of symptoms, the presence of complications, and the overall health of the patient. Side effects of antibiotics can vary but may include gastrointestinal upset, allergic reactions, and interactions with other medications. It is essential to discuss any concerns about side effects with your healthcare provider.

In summary, it is crucial to maintain open communication with your healthcare provider regarding your symptoms and treatment plan. Regular follow-ups and monitoring are essential to ensure that any potential complications are addressed promptly. If you have ongoing concerns about your reproductive health or the risk of PID, do not hesitate to seek a second opinion or further evaluation from a specialist in reproductive health or infectious diseases. Your health and well-being are paramount, especially as you consider future pregnancies.

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