Abscess of a duglasov of space
Abscess of a duglasov of space – the encapsulated purulent center located in a uterine pryamokishechnom (pryamokishechno-puzyrny) deepening of a small pelvis. The clinic of abscess of a duglasov of space is characterized by nonspecific manifestations (intoxication, febrilny temperature, oznoba) and local symptomatology (pain in the lower departments of a stomach, the dizurichesky phenomena, frequent desires on defecation). Diagnosis of abscess of a small pelvis includes rectal and vaginal (at women) a research, ultrasonography of a small pelvis, KT, an abscess puncture through a rectum or the back arch of a vagina. Treatment of abscess of a duglasov of space consists in its opening through a rectum or a vagina, drainage and sanitation, performing antibiotic treatment.
Abscess of a duglasov of space
According to the general surgery, gynecology and operational gastroenterology abscess of a duglasov of space meets in 1-3% of cases (in 0,06-0,11% - after surgeries). Abscess of a duglasov of space is quite frequent kind of abscesses of an abdominal cavity. The encapsulated abscess at this type of abscess is formed in a uterine pryamokishechnom deepening at women and pryamokishechno-puzyrny – at men.
Abscesses of a small pelvis always have secondary character. In most cases abscess of a duglasov of space develops against the background of a destructive form of an acute appendicitis (flegmonozny, gangrenous, perforative) at a pelvic arrangement of a worm-shaped shoot. At women can lead purulent diseases of appendages to formation of abscess of a small pelvis (adneksit, ). Less often developing of abscess of a duglasov of space is preceded by perforation of a diverticulum of an obodochny gut, paraproktit, diffusion forms of peritonitis.
Flowing of blood, serous or purulent exudate in space is promoted by anatomic features of a small pelvis where bryzheechny sine and channels open. At insufficiently careful audit and a toilet of an operational wound, inadequate drainage and sanitation of a small pelvis in the deepest place of an abdominal cavity – duglasovy space conditions for formation of abscess are created.
Gnoyerodny microflora is presented by nonspecific activators (stafilokokka, intestinal and paracolibacillus, streptococci, a sinegnoyny stick, etc.). Formation of abscess of a duglasov of space is promoted by decrease in reactivity of an organism and increase in virulence of pathogenic microflora.
The organization of abscess of a duglasov of space, as a rule, occurs in 5-10 days after operation for primary purulent disease. First of all there are general nonspecific symptoms which are characterized by sudden development of a fever, temperature increase of a body to febrilny values, tachycardia, nausea, a headache. On this background feelings of a raspiraniye and sharp pains in the bottom of a stomach amplifying during the walking, the movements, physiological departures are noted.
At abscess of a duglasov of space of patients the speeded-up and painful urinations, tenezma, a liquid chair with impurity of slime and blood, an incontience of gases and a calla can disturb. The extensive abscesses surrounded with massive infiltrate sometimes lead to a rectum sdavleniye, causing mechanical intestinal impassability.
Further progressing of abscess of a duglasov of space can be complicated by break of an abscess in a free abdominal cavity or hollow bodies - a bladder, a uterus, a rectum. The long course of pelvic abscess leads to development of thrombophlebitis of pelvic veins and a tromboembolichesky disease.
Diagnosis of abscess of a duglasov of space
When collecting anamnestichesky data recently undergone operations and diseases are considered that allows to suspect probability of abscess of a duglasov of space. Palpatorno is defined morbidity in a small pelvis, the local tension of muscles, a positive symptom of Shchyotkin — Blyumberg. At a rectal or vaginal research painful tugoelastichesky infiltrate with a softening and fluctuation in the center comes to light. At women abscess of a duglasov of space is palpated above a uterus neck, the overhang of the back arch of a vagina is defined.
For differential diagnostics with tuboovarialny abscess at women ultrasonography of a small pelvis is carried out; for a prostate gland abscess exception at men – ultrasonography of a prostate. In difficult differentiable cases performance of a computer tomography can be required. For final recognition of abscess of a duglasov of space resort to a diagnostic puncture of an abscess under ultrasonic targeting through a rectum or the back arch of a vagina. The received purulent contents are exposed to a bacteriological research.
Treatment of abscess of a duglasov of space
At an infiltrative stage microenemas, antibiotics are appointed; after final formation of abscess about which judge by a softening of infiltrate and emergence of fluctuation opening of an abscess is made. Abscesses of a duglasov of space open through a wall of a rectum or through the back arch of a vagina. In the beginning the abscess puncture is carried out by a thick needle.
After receiving pus, for ensuring its free outflow from an abscess cavity, the opening on the course of a needle is cut, extends in the stupid way, and to it the dvukhprosvetny drainage is established (or a catheter with the inflated manzhetka). Postoperative sanitation of a purulent cavity is carried out.
The back kolpotomiya can be applied to opening of abscess of a duglasov of space at women. At impossibility of opening of abscess transerktalno or transvaginalno, quick access in podvzdoshny area with the subsequent introduction of a drainage to a small pelvis is used.
Forecast and prevention
At single abscess of a duglasov of space and in time the undertaken intervention a disease outcome favorable – comes recovery. Complications of abscess of a duglasov of space can develop at break of an abscess in an abdominal cavity or bodies, adjacent to it.
Prevention of abscess of a duglasov of space demands adequate audit and sanitation of an abdominal cavity at surgeries, a careful stop of bleedings, timely treatment of purulent tuboovarialny educations and a paraproktit. After the complicated appendektomiya in the postoperative period the systematic vaginal or rectal research is necessary for timely recognition of abscess of a duglasov of space.