PELVIC INFLAMMATORY DISEASE IN PATIENTS WITH BILATERAL TUBAL-LIGATION

Classic teaching has stated that women who have undergone bilateral tu bal ligation (BTL) are not susceptible to pelvic inflammatory disease (PID). The purpose of this study was to confirm the existence of PID i n patients with BTL and to compare clinical parameters of these patien ts with PID patients who have not had BTL. A retrospective chart revie w of emergency department (ED) patients diagnosed with PID over a 1-ye ar period at a large urban university hospital found 209 patients who fulfilled the criteria for a definition of PID. Of the 209 patients wi th PID, 24 (11.7%) had undergone BTL, Patients with and without BTL we re compared with respect to age, white blood cell count (WBC), tempera ture, admission rate, length of hospitalization, prior history of PID, culture results, presence of bilateral abdominal pain, presence of re bound tenderness, and complications of tube-ovarian abscess (TOA) and hydrosalpinx. Patients with BTL had lower WBCs (11,100/mu L v 14,700/m u L) and were 2.5 times less likely to be hospitalized compared to tho se patients without BTL. These results show that PID in the setting of a prior BTL not only exists but occurs with surprising frequency and deserves further study. Patients with BTL and PID may have a clinicall y milder form of PID than those patients without BTL. Copyright (C) 19 97 by W.B. Saunders Company.