Diffuse peritoneal sepsis associated with colpotomy drainage of pelvic abscess

The incidence of and mortality from diffuse peritoneal sepsis associated with the vaginal drainage of pelvic abscesses were retrospectively studied at two hospitals. During the 16-year period from 1961 through 1977 at the University of Mississippi Medical Center, 50 patients underwent colpotomy drainage of pelvic abscesses, diffuse peritoneal sepsis occurred in 5 cases (10%), and 2 of these 5 patients died (40%). During the five-year period from 1972 through 1976 at Baragwanath Hospital, 298 patients underwent colpotomy drainage of pelvic abscess, diffuse peritoneal spesis occurred in 18 cases (6%), and 4 of these 18 patients died (22%). By combining the two series, a total of 348 cases of colpotomy drainage yielded 23 instances of diffuse peritoneal sepsis (6.5%0, with six deaths attributable to this condition (26%). The overall mortality for the 348 cases was 2% (seven deaths), and diffuse peritoneal sepsis was the cause of six of the seven fatalities. It is concluded that colpotomy drainage of pelvic abscesses is a safe and most effective procedure provided that the cases are well selected and the postoperative course is closely followed. Neglect of these basic principles may result in the development of diffuse peritoneal sepsis in a small but important group of patients.