[Reprinted from The Medical News, April 14, 1894.) 
A PELVIC ABSCESS OF UNUSUAL COURSE 
AND TERMINATION. 
By W. E. SHOTWELL, M.D., 
OF DENVER, COLORADO. 
On the evening of January nth I was called to attend 
a young married woman, twenty years of age, whom I 
found suffering from intense pain in the left inguinal 
region. Upon examination I found a tumor that ex- 
tended from a point a short distance within the true 
pelvis to the superior spinous process of the ilium on 
the left, and nearly to the umbilicus and median line of 
the abdomen on the right side. It was closely adherent 
to the left and posterior portion of the uterus. I could 
not elicit fluctuation. The tumor was very tense, was 
movable, and was sensitive to touch. The left tube and 
ovary were incorporated in the mass. 
While the possibility of its being a pelvic abscess 
occurred to me, I could obtain no history of pus-forma- 
tion. The patient had been and was in good health and 
flesh. She had had exacerbations of pain in this side 
at long intervals since childhood ; otherwise she had 
suffered no inconvenience from the tumor and was not 
aware she had one. There was no history of pus-dis- 
charge through the utero-vaginal track. Menstruation 
was regular and normal; she denied ever having had an 
abortion. As she had just had her menses, she attrib- 
uted her present trouble to taking “ cold.” Fearing the 
grave nature of the tumor, I endeavored to impress 
upon the woman the constant danger to which she was 
exposed and urged an immediate operation. As she 2 
was soon relieved of suffering and felt “ all right again,” 
the proposition was rejected, at least for the present. On 
February gth she came to my office to consult me on 
another matter, and before leaving I questioned her 
about the tumor. She said it gave her no trouble and 
she felt perfectly well on that side. 
On February 22d she came to my office suffering, as 
she thought, from “piles.” Upon examination I found 
an inflammatory mass nearly surrounding the lower 
part of the rectum and extending well into the lower 
portion of the left ischio-rectal fossa. It was very sensi- 
tive to touch and gave her a great deal of pain. She 
was feverish and very nervous. There was a line of 
tenderness along the rectum leading toward the tumor. 
The tumor itself gave her no trouble and presented the 
same general characteristics as on the former examina- 
tion, excepting an absence of all pain and tenderness. 
While the symptoms were in the main those of a pend- 
ing ischio-rectal abscess, I was suspicious of the line of 
tenderness along the rectum. On the evening of Feb- 
ruary 23d, as there was considerable tumefaction of the 
parts, I made a deep incision at the most prominent 
point, about one inch in length and a half-inch pos- 
teriorly, and to the left of the anus. I obtained no pus 
at the time, but within a few hours, she told me, it began 
to discharge through the incision, and for two days the 
pus “ poured” out. 
On the 27th of February the discharge ceased. The 
pain, fever, and nervousness were gone, and the patient 
felt perfectly well. She said to me, “ Doctor, my bowels 
feel so flat, and I cannot find the tumor.” It was true 
that there was not a trace of the tumor left. Such a 
favorable termination of so large a pelvic abscess must 
be very rare.