PELVIC CELLULITIS. 
By E. L. B. GODFREY, A.M., M.D., 
Physician and Gynaecologist to the Cooper Hospital, Camden 
N. J. ; Lecturer on Gynaecology at the Medico-Chirurgical 
College of Philadelphia. 
THE interspaces between the organs and 
tissues within the pelvis are filled with 
cellular tissue. But the cellular tissue sur- 
rounding the supra-vaginal portion of the 
neck of the uterus, and that lying between the 
folds of the broad ligaments, is the seat of the 
cellular inflammation within the pelvis so 
common in women who have borne children. 
It is rare to examine a multi para without find- 
ing evidences of pelvic cellulitis or parametri- 
tis. Injuries incident to parturition largely 
account for this, and among them laceration of 
the cervical canal is, perhaps, the most com- 
mon, occurring, as it does, in about 30 per 
cent, of all cases. Septic matter is carried 
from the injured and abraded surfaces, by means 
of the blood-vessels and the lymphatics, to the 
cellular structure, and the cellulitis that follows 
becomes septic in character. The Fallopian, 
tubes are not affected, unless pelvic cellulitis 
is secondary to pelvic peritonitis resulting from an extension of inflammation from the 
tubes to the peritoneum. Primary pelvic cel- 
lulitis and inflammation of the tubes are, how- 
ever, associated, in cases of a high grade of 
inflammation, or when both are of long stand- 
ing. The frequent association of the two has 
led some to believe that pelvic cellulitis is an 
outgrowth of tubal disease, instead of resulting 
primarily from septic contamination from par- 
turient injuries. When the association is 
present, pelvic peritonitis is the intervening 
link. 
Pelvic cellulitis is easily recognized by means 
of a vaginal examination. Tenderness and 
hardness of the lateral uterine fornices, partial 
obliteration of the uterine cervix, and more or 
less a limitation to the natural mobility of 
the uterus indicate both the presence and 
degree of cellulitis. If the inflammatory 
exudation has been great, a tumor of a vary- 
ing size may be found on either side of the 
uterine cervix, pushing the uterus in the oppo- 
site direction. If the tumor is large and 
extends above the superior strait of the pelvis, 
it may be felt through the abdominal wall. 
The tumor may disappear by resolution or pass 
into a state of suppuration, and the pus may 
escape through the vagina, bladder, rectum, or 
abdominal walls. Pelvic cellulitis, especially when following 
parturition, should be early recognized. The 
efforts of treatment should be directed to the 
controlling of pain and to limiting the ten- 
dency to an exudation. Opium, for the relief 
of pain; counter irritants or hot applications 
over the uterus, and the use of the hot, anti- 
septic, vaginal douche for limiting the exuda- 
tion ; and quinine and supporting measures, if 
suppuration follows. Should an exudation 
take place, the tumor may pass away by reso- 
lution, and, if pus forms, it may find its way 
out through the vagina, bladder, rectum, or 
the abdominal walls. In the event of pus 
being retained, aspiration should be performed, 
and the operation repeated, if the sac refills. 
If the pus secreting character of the sac 
remains after aspiration has been once repeated, 
the introduction of a drainage-tube into the 
sac and flushing the sac-cavity with an anti- 
septic solution may be required. When the 
abscess cannot be reached per vaginam, and 
septicaemia threatens, laparotomy and drainage 
through the abdominal walls are called for. Reprinted from “The Medical Bulletin,” 
November, 1891.