Pelvic fluid collections by sonography and febrile morbidity after abdominal hysterectomy

To assess the range of normal findings at endovaginal sonography after abdominal hysterectomy and to assess the relation between these findings and febrile morbidity. Fifty-eight women had endovaginal ultrasound at a median of 4 days after abdominal hysterectomy. The volume of fluid in the cul-de-sac and its sonographic characteristics were assessed. Ultrasound findings, which were not released to the patients' physicians, were correlated with febrile morbidity and clinical outcomes. The median pelvic fluid volume was 3.4 mL (interquartile range 0–16.8 mL). No pelvic fluid was detected in 22 of 58 women (37.9%). In the other 36 women, fluid volumes ranged between 0.2 and 76.3 mL. Febrile morbidity was present in 15 of 58 women (26%) overall: eight of 36 (25%) with and seven of 22 (32%) without pelvic fluid. There was no association between the presence of pelvic fluid collections and febrile morbidity ( P = .54) or prolonged fever ( P = 1.00). There was no difference in the median or mean fluid volumes between women with and without febrile morbidity. The study had a power of 90% with α = .05 to detect a difference of 20 mL. Even women with fixed, markedly echoic fluid collections larger than 35 mL did not have significantly more febrile morbidity than women with no pelvic fluid ( P = .33). The volume of pelvic fluid 3–5 days after hysterectomy does not predict febrile morbidity or the need for drainage. Large or complex fluid collections may be present without adverse clinical consequences, and discovering such a collection in a patient with febrile morbidity after hysterectomy does not necessitate antibiotic therapy or surgical drainage of the fluid collection.