Septic Pelvic Thrombophlebitis

CLINICAL FEATURES Septic pelvic thrombophlebitis (SPT) is a diagnosis of exclusion complicating 0.1 to 0.5 percent of gynecologic procedures. The diagnosis is made when a patient with a postoperative fever does not respond to appropriate antibiotics in the absence of an undrained abscess or infected hematoma. Patients with SPT rarely present to the emergency department, since the complication typically presents in the hospital and delays discharge.

There are two forms of SPT. The classic form occurs 2 to 4 days after abdominal surgery and is characterized by fever, tachycardia, gastrointestinal distress, and unilateral abdominal pain. A palpable abdominal cord is seen in 50 to 67 percent of cases. The enigmatic form complicates vaginal delivery and pelvic surgery. Patients have spiking fevers despite clinical improvement on antibiotics. Findings upon pelvic examination may be normal in patients with either form.

DISPOSITION Heparin for 7 to 10 days is the mainstay of treatment. Long-term anticoagulation is not needed unless septic pulmonary emboli have occurred. Antibiotics against heparinase-producing Bacterioides species should be given to all patients.

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