Management of Dilation and Curettage in the Presence of an Abscess

Critical Initial Assessment

The World Journal of Emergency Surgery recommends obtaining a focused history including fever, pelvic pain severity, vaginal discharge, and immunocompromised status in patients with an abscess, to guide initial assessment and management 1, 2
A complete physical examination with pelvic examination is necessary to assess abscess location and extent, according to the World Journal of Emergency Surgery 1, 2
Checking serum glucose, hemoglobin A1c, and urine ketones is crucial to identify undiagnosed diabetes mellitus, which is common in abscess patients, as recommended by the World Journal of Emergency Surgery 1, 2
For patients with systemic infection or sepsis signs, obtaining complete blood count, serum creatinine, C-reactive protein, procalcitonin, and lactate levels is essential, as suggested by the World Journal of Emergency Surgery 1, 2

The World Journal of Emergency Surgery suggests using MRI, CT scan with IV contrast, or endoscopic ultrasound based on abscess location and available resources, to guide procedural intervention 1, 2
Imaging is mandatory for atypical presentations or suspected complex/deep abscesses, according to the World Journal of Emergency Surgery 1, 2
Looking for abscess size, location, presence of loculations, and proximity to vital structures is crucial, as recommended by the World Journal of Emergency Surgery 3

The World Journal of Emergency Surgery recommends surgical drainage with incision and drainage as the definitive treatment, which must precede any D&C procedure 1, 2, 4
For accessible abscesses, performing incision and drainage as close to the abscess as possible while ensuring adequate drainage is necessary, as suggested by the World Journal of Emergency Surgery 1, 2, 4
Time surgery based on sepsis severity—emergent drainage required for sepsis, immunosuppression, or diffuse cellulitis, according to the World Journal of Emergency Surgery 1, 4
Consider percutaneous drainage (US or CT-guided) for deep pelvic abscesses that are accessible, as recommended by the World Journal of Emergency Surgery 3, 5, 6

The World Journal of Emergency Surgery suggests initiating broad-spectrum antibiotics covering Gram-negative bacteria and anaerobes, such as Piperacillin/tazobactam 4 g/0.5 g q6h for 4 days, for immunocompetent, non-critically ill patients with adequate source control 5, 6, 7
Alternative antibiotics include Ertapenem 1 g q24h and Eravacycline 1 mg/kg q12h, as recommended by the World Journal of Emergency Surgery 5, 6, 7
For immunocompromised or critically ill patients, continuing antibiotics up to 7 days based on clinical response and inflammatory markers is essential, according to the World Journal of Emergency Surgery 5, 6, 7

The World Journal of Emergency Surgery recommends proceeding with D&C only after complete drainage of abscess with clinical improvement, completion of appropriate antibiotic course, and resolution of sepsis if present 1, 2, 3, 5, 6
Repeat imaging should confirm abscess resolution if initial abscess was large or complex, as suggested by the World Journal of Emergency Surgery 3

The World Journal of Emergency Surgery warns against relying on antibiotics alone for abscesses >3 cm or in immunocompromised patients without attempting drainage, as this may increase recurrence risk 3, 5, 6
Avoid inadequate drainage or failure to identify loculations, which increases recurrence risk, according to the World Journal of Emergency Surgery 4
Do not discontinue antibiotics prematurely, as patients requiring >7 days of treatment warrant diagnostic re-evaluation, as recommended by the World Journal of Emergency Surgery 5, 6, 7