antibiotic treatment of those patients at highest risk of subsequent ectopic pregnancy and infertility ( Fig 92.3 ) A complication of PID that warrants prompt diagnosis is ruptured tuboovarian abscess About 15% of tuboovarian abscesses rupture spontaneously The symptoms and signs of a ruptured abscess may be mild if only a small amount of pus has leaked out, but the usual clinical picture includes peritonitis and shock A pelvic mass is palpable in less than one-half the cases Prompt surgical intervention can be lifesaving Perihepatitis (Fitz-Hugh–Curtis syndrome), consisting of right upper quadrant pain and tenderness produced by inflammation of the liver capsule in association with PID, occurs in 4% to 30% of cases of PID and is more likely to occur with gonococcal infection and more severe diseases On transvaginal ultrasonography, about one-third of patients with PID will have visible fallopian tubes and about one-fifth will have a demonstrable tuboovarian abscess ( Fig 92.4 ) Laparoscopy confirms the diagnosis of PID in only about 60% of patients who are suspected, either by gynecologists or by primary care physicians, on clinical grounds of having the disease Conditions most often mistaken for PID are acute appendicitis, endometriosis, hemorrhagic and nonhemorrhagic ovarian cysts, and ectopic pregnancy In up to 25% of women judged clinically to have PID, no abnormality can be identified laparoscopically