Interintestinal abscess – the delimited abscess of an abdominal cavity which is formed between intestinal loops, a belly wall, a bryzheyka and an epiploon. The clinic of interintestinal abscess is characterized by temperature of gektichesky character, intoxication, an abdominal cavity pain, sometimes hypostasis and hyperaemia of a forward belly wall. For the purpose of diagnosis of interintestinal abscess use a survey X-ray analysis of an abdominal cavity, ultrasonography and KT. Treatment of interintestinal abscess – quick: laparotomy, opening and drainage of a cavity of an abscess; performing antibacterial therapy is obligatory.
Interintestinal abscess is considered in gastroenterology as private option of abscess of an abdominal cavity. Bryzheyka cross guts serves as the anatomic barrier interfering distribution of an abscess on the top floors of an abdominal cavity. Interintestinal abscess is quite often combined with abscess of a duglasov of space, appendicular abscess. By the number of the created purulent cavities interintestinal abscesses often happen multiple.
Reasons of formation of interintestinal abscess
Most often development of interintestinal abscesses is connected with perforative stomach ulcer or a 12-perstny gut, the acute probodny appendicitis complicated divertikulity intestines, cholecystitis, cancer of a large intestine, a disease Krone. Sometimes as the reason of formation of interintestinal abscess serves insolvency of seams of a gut and anastomoz. Osumkovanny abscesses in interintestinal space are formed as the residual phenomena accompanying the postponed diffusion peritonitis.
Otgranicheny a purulent cavity it is formed when pasting a peritoneum with the subsequent unions between separate loops of a small or large intestine, their bryzheyka and an epiploon.
Symptoms of interintestinal abscess
As a rule, precedes the beginning of clinical displays of interintestinal abscess poured the peritonitis caused by the complicated course of primary disease. Usually against the background of the seeming recovery patients have dull abdominal aches, an indisposition, a meteorizm, vomiting, locks again. The projection of belly-aches corresponds to localization of interintestinal abscess. At the interintestinal abscesses located close to a surface of a forward belly wall asymmetry of a stomach, hypostasis and hyperaemia of skin, tension of muscles is observed.
In the beginning the abscess can not be defined, later it is palpated in the form of soft, elastichesky opukholevidny education, motionless and painful, sometimes with fluctuation (zybleniye) in the center. The temperature curve gains gektichesky character with considerable daily fluctuations of body temperature; on this background intoxication symptoms are brightly expressed. Interintestinal abscesses can be followed by the phenomena of mechanical or dynamic intestinal impassability.
At break of interintestinal abscess in a gleam of a gut there can occur self-healing or be formed fistula. More often, however, interintestinal abscess breaks in a free abdominal cavity that leads to formation of new osumkovanny abscesses or development of the poured peritonitis.
Diagnosis of interintestinal abscess
In view of not specificity of displays of interintestinal abscess diagnostics presents certain difficulties, especially when it is not possible to establish relationship of cause and effect with primary disease. Recently postponed peritonitis or an abdominal cavity operations, existence in the anamnesis of nonspecific ulcer colitis, a divertikulit, an ulcer, disease Krone etc. have to form the bases for suspicion of interintestinal abscess.
Changes in peripheral blood are characterized leykotsitozy, shift of a formula to the left, by acceleration of SOE. At a palpation of a stomach the local tension of muscles of a stomach, sharp morbidity, motionless pathological tugoelastichesky infiltrate decides on a softening in the center.
At a survey X-ray analysis of an abdominal cavity blackout in abscess projections, level of liquid and symptoms of paresis of intestines comes to light; at a X-ray analysis of a passage of barium deformation of loops of intestines is visible. Finally ultrasonography of abdominal organs, MSKT of an abdominal cavity allow to resolve issues of diagnosis of interintestinal abscess.
Treatment of interintestinal abscess
In an infiltrative stage conservative treatment is carried out: antibacterial medicines, dezintoksikatsionny therapy, GIT function regulation are appointed.
After an otgranicheniye of interintestinal abscess surgery is made: laparotomy, opening and drainage of a purulent cavity. Postoperative tactics includes change of tampons, pus aspiration, washing of drainages, vnutribryushinny introduction of antibiotics. Also system antimicrobic therapy, fight against intoxication, dehydration, a gipoproteinemiya continues.
In case of break of an abscess in an abdominal cavity or development of intestinal impassability, operation is performed in the emergency order. In certain cases the resection of a part of a gut can be required.
Forecast and prevention of abscesses of an abdominal cavity
At timely detection and adequate medical tactics the forecast is more often favorable. Multiple interintestinal abscesses are always an adverse predictive factor. Their break in an abdominal cavity, peritonitis, sepsis can become complications of interintestinal abscesses.
Prevention of formation of interintestinal abscesses consists in timely treatment of diseases of bodies of a GIT, careful audit of an abdominal cavity at surgeries, attentive postoperative maintaining the patients who had peritonitis.