Pelvic fluid collections following hysterectomy and their relation to febrile morbidity

To determine the incidence of pelvic fluid collections after hysterectomy, detected by transvaginal sonography and pelvic examination, and to correlate these findings with postoperative febrile morbidity.

Thirty-eight women, aged 26-65, were studied by pelvic examination and transvaginal sonography 1-5 days after vaginal or abdominal hysterectomy. The sonographer was unaware of the patient's clinical course before the examination and was not involved in clinical decision making. The results of the study were not made available to the treating physician.

Transvaginal sonography revealed a sonolucent mass consistent with a fluid collection above the vaginal cuff ranging in size from 3.9-74.7 cm3 in 13 of 38 patients (34.2%). Only one of the 13 fluid collections was evident on pelvic examination performed before ultrasound. Nine of 13 women (69.2%) with fluid collections developed febrile morbidity, compared to three of 25 (12%) who did not have fluid collections (P = .006, Fisher exact test). Cuff cellulitis was clinically diagnosed in seven of the 13 women (53.8%) with fluid collections, compared to none of 25 women without fluid collections (P < .001, Fisher exact test).

Pelvic fluid collections are common after hysterectomy. Women who develop post-hysterectomy fluid collections appear to be at increased risk for the development of febrile morbidity and cuff cellulitis. Transvaginal sonography may facilitate the diagnosis of post-hysterectomy pelvic fluid collections, which are not readily detected by pelvic examination.