Abscess of an abdominal cavity
Abscess of an abdominal cavity – the limited abscess in an abdominal cavity concluded in the piogenny capsule. Features of clinic depend on localization and the size of the purulent center; as the general displays of abscess of an abdominal cavity serve pain and local tension of muscles of a stomach, fever, intestinal impassability, nausea, etc. Diagnosis of abscess includes a survey X-ray analysis of abdominal organs, ultrasonography and KT of an abdominal cavity. Treatment of abscess of an abdominal cavity consists in opening, drainage and sanitation of an abscess; massive antibacterial therapy.
Abscess of an abdominal cavity
In a broad sense the operational gastroenterology carries vnutribryushinny (intraperitonealny), zabryushinny (retroperitoneal) and intraorganny (intra organ) abscesses to abscesses of an abdominal cavity. Vnutribryushinny and zabryushinny abscesses, as a rule, settle down in the field of anatomic channels, pockets, bags of an abdominal cavity and cellular spaces of retroperitoneal cellulose. Intra organ abscesses of an abdominal cavity are more often formed in a parenchyma of a liver, pancreas or walls of bodies.
Plastic properties of a peritoneum, and also existence of unions between its parietal leaf, an epiploon and bodies, promote an otgranicheniye of an inflammation and formation of the peculiar piogenny capsule interfering distribution of purulent process. Therefore abscess of an abdominal cavity is called still "the delimited peritonitis".
In most cases formation of abscesses of an abdominal cavity is connected with the secondary peritonitis developing owing to hit in a free abdominal cavity of intestinal contents at perforative appendicitis; blood, an exudate and pus at drainage of hematomas, insolvency of anastomoz, a postoperative pankreonekroz, injuries etc.
In 75% of cases abscesses of an abdominal cavity settle down inside - or zabryushinno; in 25% - vnutriorganno. Usually abscess of an abdominal cavity is formed several weeks later after development of peritonitis. As typical places of localization of abscesses of an abdominal cavity serve the big epiploon, a bryzheyka, a small pelvis, lumbar area, poddiafragmalny space, a surface or thickness of fabrics of parenchymatous bodies.
Purulent inflammations of female genitals can act as the reason of abscess of an abdominal cavity – sharp salpingit, adneksit, a parametritis, , , tuboovarialny abscess. The abscesses of an abdominal cavity caused by pancreatitis meet: in this case their development coherently with the effect of enzymes of a pancreas on surrounding cellulose causing the expressed inflammatory reaction. In certain cases abscess of an abdominal cavity develops as a complication of sharp cholecystitis or perforation of stomach ulcer and a 12-perstny gut, a disease Krone.
Psoas-abstsess (or abscess of a podvzdoshno-lumbar muscle) can be a consequence of osteomyelitis of a backbone, a tubercular spondilit, paranephrite. Piogenny flora of abscesses of an abdominal cavity more often polymicrobic, combining aerobic (colibacillus, proteas, staphylococcus, streptococci, etc.) and anaerobic (klostridiya, bakteroida, fuzobakteriya) microbic associations.
Classification of abscesses of an abdominal cavity
On the leading etiofaktor distinguish microbic (bacterial), parasitic and necrotic (abacterial) abscesses of an abdominal cavity. According to the pathogenetic mechanism allocate
Concerning a peritoneum abscesses of an abdominal cavity are divided by an arrangement on zabryushinny, vnutribryushinny and combined; by quantity of abscesses - single or multiple. On localization pristenochny and intra organ abscesses meet poddiafragmalny, interintestinal, appendicular, pelvic (abscesses of a duglasov of space) (vnutribryzheechny, abscesses of a pancreas, liver, spleen).
Symptoms of abscess of an abdominal cavity
At the beginning of a disease at any kind of abscess of an abdominal cavity the general symptomatology prevails: intoxication, the intermittiruyushchy (alternating) fever with a gektichesky temperature, oznoba, tachycardia. Often at abscess of an abdominal cavity nausea, appetite violation, vomiting is noted; paralytic intestinal impassability develops, the expressed morbidity in an abscess zone, tension of belly muscles is defined.
The symptom of tension of muscles of a stomach is most expressed at the abscesses of an abdominal cavity which are localized in a mezogastriya; abscesses of poddiafragmalny localization, as a rule, proceed with the erased local symptomatology. At poddiafragmalny abscesses pain in a podreberye on a breath with irradiation in a shoulder and a shovel, cough, short wind can disturb.
Symptoms of pelvic abscesses include abdominal pains, increase of an urination, a diarrhea and tenezma owing to reflex irritation of a bladder and intestines. Localization of pain in the lower departments of a back is characteristic of zabryushinny abscesses; at the same time intensity of pain amplifies when bending the lower extremity in a coxofemoral joint. Expressiveness of symptomatology at abscess of an abdominal cavity is connected with the size and localization of an abscess, and also with intensity of the carried-out antimicrobic therapy.
Usually at primary survey the compelled position of the patient which it accepts for simplification of the state pays attention: lying on one side or a back, semi-sitting, having bent etc. Language dry, is laid over by a grayish raid, the stomach is blown slightly up. The stomach palpation at abscess of an abdominal cavity finds morbidity in the departments corresponding to localization of purulent education (in a podreberye, basin depth, etc.). Existence of poddiafragmalny abscess is characterized by asymmetry of a thorax, we stick out mezhreberiya and the lower edges.
In the general blood test at abscess of an abdominal cavity are found , , acceleration of SOE. The crucial role in diagnosis of abscess of an abdominal cavity is assigned to radiological inspection. As governed, the survey X-ray analysis of an abdominal cavity allows to reveal additional education with liquid level. At contrast research GIT (a X-ray analysis of a gullet and a stomach, an irrigoskopiya, a fistulografiya) the pushing off of a stomach or loops of intestines is defined by infiltrate. At insolvency of postoperative seams contrast substance comes from intestines to an abscess cavity.
Ultrasonography of an abdominal cavity most informatively at abscess of its top departments. At difficulties of differential diagnosis of abscess of an abdominal cavity carrying out KT, diagnostic laparoscopy is shown.
Treatment of abscesses of an abdominal cavity
Surgical treatment of abscess of an abdominal cavity is carried out under cover of antibacterial therapy (aminoglycosides, tsefalosporin, ftorkhinolon, imidazole derivatives) for suppression of aerobic and anaerobic microflora.
The principles of expeditious treatment of all types of abscesses of an abdominal cavity consist in opening and drainage, carrying out adequate sanitation. Access to abscess of an abdominal cavity is defined by its localization: poddiafragmalny abscesses open vnebryushinno or chrezbryushinno; abscesses of a duglasov of space – transrektalno or transvaginalno; psoas-abscess – from lyumbotomichesky access etc. In the presence of multiple abscesses broad opening of an abdominal cavity is carried out. After operation leave a drainage for active aspiration and washing.
Small single poddiafragmalny abscesses can be trained chrezkozhno under ultrasonic targeting. However at incomplete evacuation of pus the probability of a recurrence of an abscess or its development in other place of subdiafragmalny space is high.
Forecast and prevention
At single abscess of an abdominal cavity the forecast is more often favorable. The break of pus in a free pleural or abdominal cavity, peritonitis, sepsis can be complications of abscess.
Prevention of abscesses of an abdominal cavity demands timely elimination of sharp surgical pathology, gastroenterologichesky diseases, inflammations from a female genital, adequate maintaining the postoperative period after interventions on abdominal organs.