Presentation
Vaginal hysterectomy several weeks prior, presenting with continued vaginal bleeding, severe abdominal pain, and severe back pain. There is severe tenderness to palpation across the entire abdomen and lower back with guarding. Lab results significant for leucocytosis.
Patient Data
1. At least two large loculated fluid collections with rim enhancement measuring up to 10.2 cm in the right paracolic gutter and 13.6 cm in the pelvis. These may represent seromas in the postsurgical setting versus abscesses.
2. Mild mesenteric fat stranding in the lower abdomen and pelvis, likely related to postsurgical changes within acute inflammatory process not excluded.
3. Additional cystic focus in the left pelvis measuring approximately 2.4 cm which may represent an additional loculated fluid collection versus cyst arising from the left ovary.
4. Small to moderate left pleural effusion with adjacent atelectasis.
5. Minimal subcutaneous emphysema along the right lower ventral abdominal wall, may represent postsurgical changes versus infection.
Interval decrease in the size of the thick-walled multiloculated pelvic fluid collection, now measuring 6.8 x 3.0 cm (previously 13.6 x 6.5 cm on CT). A pigtail catheter terminates within the fluid collection.
A second pigtail drainage catheter terminates in the right paracolic gutter, with interval resolution of the previously reported right paracolic gutter fluid collection.
Case Discussion
This case is an example of multiple postoperative pelvic and abdominal abscesses. The interventional radiology team placed Jackson-Pratt drains, and fluid culture grew Streptococcus agalactiae. The patient's symptoms significantly improved from abscess drainage and antibiotics.
The pleural effusion had resolved without intervention.
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