DISEASES OF FEMALE GENITAL ORGANS : PELVIURETERIC, LIMITED PELVIC PERITONITIS (PELVEOPERITONITIS) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Infection with pyogenic microbes adjacent organs, usually from the pipe parameters, the postpartum (post-abortion) the period from the uterus, vagina, by metastatic, cancers of the uterus, decaying fibroids, sometimes diseases of the bowel.
The pathogenesis. Inflammation of the pelvic peritoneum, arising either due to the direct transfer of infection through cracks, tears and ruptures of the vaginal mucosa, cervix, from the lumen of the pipe or as a metastasis. Rapid delimitation of the inflammatory focus and the formation of serous at first, and then purulent exudate.
High temperature increasing step, pulse speeded up. Sharp abdominal pain, respiratory movements of the abdominal wall are absent or weakly expressed. Peritoneal phenomena. Pronounced symptom Shchetkina (Blumberg). Defecation and urination painful. The General condition is greatly disturbed. Further pain tend to subsided. Purulent leucorrhea. Vaginal (better rectovaginal) examination - the rear arch is tense, painful; the remaining departments of the pelvic cellular tissue in a state of pronounced edema. The lower pole of the inflammatory tumor bulges anterior wall of the rectum. The tumor is elastic consistency, painful, is not transferred to the walls of the pelvis. Negative symptom Genter (percussion sound at crista ilei gives tympanitis). If there is no suppuration, exudation wrinkled, formed adhesions and thickening of the peritoneum. Subsequently, frequent exacerbations as a result of enhanced movements, rough medical manipulation, excessive sexual intercourse. Menstrual dysfunction.
Complications. General diffuse peritonitis, thrombophlebitis. Spontaneous opening of the abscess into the rectum, the bladder. Partial intestinal obstruction (especially in cases of chronic recurrent of perioperativ).
Carefully collected history. Vaginal-rectal examination to differentsirovat pelvic peritonitis from of parametritis (see), blood tumor, when terminate an ectopic pregnancy, appendicitis, tumors. Diagnosis in most cases is specified by means of puncture of the posterior fornix (serous or purulent fluid).
Prediction in the absence of complications a good.
In acute cases, rest, ice on the lower abdomen, candles with belladonna; light diet; bloating bowel enema (siphon), a gas outlet tube. Penicillin, sulfonamides and transfusion of small doses of blood, the introduction of large amounts of fluid intravenously and intramuscularly (glucose). Symptomatic and heart funds. When suppuration surgical treatment (back colpotomy), drainage, followed by an introduction into the cavity of the abscess penicillin, penicillin intramuscularly, sulfonamides. Transfusion of small amounts of blood (100 - 125 ml) every 2 - 3 days 3 - 4 times. Position in the bed to raise the head end of the bed or the upper half of the body (30º ).
After the process in verse and in chronic cases: exposure to ultraviolet rays (erythemal dose) simultaneously with the Solux lower abdomen; treatment replanting canned tissue or injections aloe on Filatov; ionisation, diathermy; blood transfusion or autologous hemotherapy, proteinuria; hot douching, hot enema. In the future, usually to eliminate the remaining adhesions mud (the resort or non-resort) treatment (torfolechenie, paraffin, ozocerite treatment.