title: [Infected hematoma of Douglas pouch: a specific complication of the surgical excision of deep endometriosis involving the vagina].
abstract: OBJECTIVE
  Surgical management of deep pelvic endometriosis may be responsible for various complications, such as infected pelvic haematic collection of the Douglas pouch. The aim of this study is to describe this unfavourable outcome and to estimate its frequency in the series of women managed by our team.
  
  
  METHODS
  Retrospective study enrolling 163 women undergoing surgical removal of deep posterior endometriosis involving the vagina, from January 2008 to September 2011. We indentified women presenting with postoperative fever associated with computed tomographic findings suggesting an abscess of the Douglas pouch. Women characteristics, complication's management and outcomes were analysed in each case.
  
  
  RESULTS
  Ten patients presented an inflammatory syndrome associated to hypothetical Douglas pouch abscess, revealed 6 days postoperatively on average. All women reported increasing pelvic pain, fever higher than 38.5°C, increased level of leucocytes and C reactive protein, and liquid collection of the Douglas pouch. Surgical management was carried out in nine women, revealing a pelvic collection of cloudy haematic liquid. Various bacteria were identified in six cases out of nine, suggesting liquid contamination through vagina opening. Postoperative outcome were immediately favourable.
  
  
  CONCLUSIONS
  Inflammatory syndrome associated with infected haematic collection of the Douglas pouch is a postoperative complication of the surgical removal of deep endometriosis involving the posterior vagina. Surgical removal of the haematic collection allows rapid and definitive favourable outcomes.
authors.affiliation: Clinique gynécologique et obstétricale, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Sanguin
authors.forename: H
authors.initials: H
authors.lastname: Roman
authors.forename: M
authors.initials: M
authors.lastname: Vassilieff
authors.forename: V
authors.initials: V
authors.lastname: Bridoux
authors.forename: C
authors.initials: C
authors.lastname: Da Costa
authors.forename: C
authors.initials: C
authors.lastname: Martin
authors.forename: L
authors.initials: L
authors.lastname: Marpeau
authors.forename: L
authors.initials: L
authors.lastname: Puscasiu
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications*; D004312:Douglas' Pouch; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000382:microbiology*; D006801:Humans; D008875:Middle Aged; D017699:Pelvic Pain; D010532:Peritoneal Diseases; D011183:Postoperative Complications / Q000382:microbiology*; D012189:Retrospective Studies; D014623:Vaginal Diseases / Q000601:surgery*