In acute pelvic infections, the mature judgment gained by long experience as to when and how to operate is of paramount importance. Rules of procedure may be laid down, but their proper application is a matter of personal equation.
To operate during the storm of pelvic flare-up frequently spells disaster. Nature must be given an opportunity to corral the infection by adhesions, and to develop immunity against the specific infection. However, if the patient is seen early and the diagnosis is positive, it is good practice to operate immediately. A history of previous attacks will aid materially in determining the course to pursue. Evidences of beginning general peritonitis, such as very rapid pulse or hyperpyrexia, with general abdominal rigidity and tenderness, are counter-indications to early surgical interference.
Cases which develop cellulitis accompanied by a full round cul-de-sac are best treated by a posterior vaginal puncture and a double drainage tube inserted
BOWERS LG. THE PROPER OPERATIVE PERIOD AND METHODS OF DRAINAGE IN PELVIC INFECTIONS. JAMA. 1911;LVII(22):1737–1738. doi:10.1001/jama.1911.04260110237002
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