Intestines abscess – the defeat of a wall of intestines which is a consequence of transition of pyoinflammatory process from nearby bodies or limfogenny or hematogenic spread of an infection from other centers. The disease can proceed with violently developing symptomatology, a hyperthermia, a sharp pain syndrome against the background of a serious general condition or in a recidivous form. A basis of diagnostics is the characteristic clinical picture, results of ultrasonography yielded by KT. Treatment of a disease – surgical, carried out against the background of massive antibacterial therapy.
Intestines abscess – the limited center of a purulent inflammation in an intestines wall. The gastroenterology considers this pathology as a form of pyoinflammatory processes in an abdominal cavity, transition of purulent process from the next bodies or as a complication of surgical interventions in an abdominal cavity. Anatomo-fiziologichesky features of an abdominal cavity, including property of a peritoneum, topography of bodies cause formation of the limited inflammatory center in intestines. In certain cases abscess in intestines can be created as a result of hematogenic (with blood current) or limfogenny (with lymph current) an infection drift even from the remote purulent centers, for example, at quinsy, osteomyelitis, a furunkuleza. In 8% of cases the concrete reason of development of abscess of intestines does not manage to be established.
The major etiologichesky factor of development of a disease is colibacillus – in more than to a half of cases, also the activator can be staphylococcus – 9-11%, a streptococcus – 7-10%, a sinegnoyny stick – 7-8%, proteas – 5-8%, to 25% - anaerobic flora.
Abscess can develop as a result of direct (contact) transition of an infection from adjacent areas, as a result of perforation, a penetration of an ulcer of a duodenum or other department of intestines, destructive appendicitis, peritonitis. Not less frequent reason – postoperative complications: abscess can be a consequence of insufficiently effective drainage, incomplete removal of an exudate or the damaged fabrics, suppurations of a postoperative hematoma; to be formed on the course of the wound channel, around foreign matters (including drainages).
The limited purulent inflammation can be organized in several ways: formation of the center in the place of hit of the infectious agent, suppuration of the infected exudate, a congestion of blood or bile in the field of the surgical intervention and also passing with restriction from the next bodies of pathological process including at peritonitis.
Intestines abscess symptoms
The clinical picture of this pathology at the initial stages is defined by its reason, that is the main disease: cholecystitis, stomach ulcer, appendicitis, injury of an abdominal cavity or another. At a complication of the main disease of abscess of intestines the characteristic symptomatology develops: sharp intensive temperature increase of a body, considerable deterioration in the general condition of the patient, an oznoba, the expressed an abdominal cavity pain (its localization depends on the place of formation of abscess).
Allocate three options of a course of a disease. In most cases process begins violently, with a hyperthermia, the expressed pain syndrome, the general condition of the patient heavy. This current is defined by bystry increase of infiltrate in an abdominal cavity. At inertly formed infiltrate the course of a disease is characterized by bystry development of fever at smooth increase of intensity of a pain syndrome.
Perhaps recidivous current at which against the background of infiltrate reduction clinical signs abate a pain syndrome becomes less expressed, but when forming in the decreased infiltrate of the limited purulent center symptoms sharply amplify
If abscess is formed in the postoperative period (as a complication of surgical intervention), development of a disease can go two ways. In the first case after operation the health of the patient improves, temperature is normalized, and after formation of the purulent center the characteristic symptomatology accrues. In the second case temperature after expeditious treatment is not normalized and remains up to opening of an abscess.
Abscess can independently break in an intestines gleam, at the same time the condition of the patient sharply improves. In case of opening of abscess in an abdominal cavity the centers of an osumkovanny purulent inflammation, poured peritonitis can be created.
The abscess localized in intestines has the clinical picture similar to other pyoinflammatory diseases of an abdominal cavity that complicates its diagnostics. The basis for the assumption of development of abscess of intestines is the characteristic symptomatology in combination with the data of the anamnesis indicating a possible source of an infection or the postponed surgical intervention. It is necessary to differentiate this disease from abscesses of an abdominal cavity of other localizations: interintestinal abscess, poddiafragmalny abscess, abscess of a duglasov of space, other intra organ abscesses.
At objective inspection of the patient the gastroenterologist determines tension of muscles of a belly wall, an abdominal distension, sharp morbidity at a palpation in a zone, the corresponding localization of abscess. Laboratory symptoms of this pathology are sharp with shift of a formula to the left, the accelerated SOE.
In diagnostics radiological methods have the defining value. The X-ray analysis of an abdominal cavity gives the chance to visualize education with the liquid level (a characteristic symptom of abscesses). When carrying out a X-ray analysis change of its internal contour in an abscess zone decides on contrasting of intestines.
At ultrasonography of abdominal organs in a zone of localization of abscess the ekhonegativny education having the capsule and non-uniform liquid contents is defined.
If at application of the described diagnostic methods diagnosis is difficult, the computer tomography, a magnetic and resonant tomography, MSKT of an abdominal cavity is carried out. These methods have high informational content.
Treatment of abscess of intestines
Basis of treatment of intestinal abscesses is surgical removal of an abscess in combination with massive antibiotic treatment. Antibiotics from groups of tsefalosporin, aminoglycosides, ftorkhinolon, effective concerning aerobic, anaerobic flora are appointed.
Surgical treatment consists in opening of the center of a purulent inflammation, its sanitation, drainage. Laparotomny access which localization is defined by the place of abscess is applied. If localization of the purulent center is accurately not defined or there were diagnostic difficulties, the median laparotomy allowing the surgeon to get access to all departments of intestines is carried out. At defeat of final departments of intestines operation through transrectal access is possible. Surely the center of a purulent inflammation is drained for the subsequent aspiration separated and washings.
Forecast and prevention
At the timely diagnostics, performing adequate surgical treatment, good drainage of the center, prescription of antibiotics having high efficiency concerning the activator the forecast of a disease favorable. Multiple abscesses, complications in the form of peritonitis, sepsis worsen the forecast.
Prevention of pathology consists in the timely request of patients for the qualified help, adequate treatment of diseases which can become the reason of abscess, high-quality audit of an abdominal cavity in the course of performing surgeries, the correct maintaining patients in the postoperative period.