Pelvioperitonit – local infectious and inflammatory defeat of a serous cover (peritoneum) of a small pelvis. Development of a pelvioperitonit is shown by high fever with oznoba, intoxication, the expressed pain abdominal syndrome, an abdominal distension and tension of muscles of a belly wall. Diagnostics of a pelvioperitonit includes carrying out gynecologic survey, ultrasonography, a laparoscopy, bakissledovaniye. Therapy of a pelvioperitonit demands purpose of massive antimicrobic, infusional therapy, UFOK, an immunnokorrektion, performance of medical punctures. At a purulent pelvioperitonit carrying out a kolpotomiya, laparoscopy and drainage of a cavity of a small pelvis is shown.
Pelvioperitonit it is characterized by local reaction of an inflammation in a small basin: disorders of the microcirculation increased by permeability of vessels, an exit out of borders of the vascular course of fibrinogen, albumine, leukocytes, formation of a serous or purulent exudate. In the struck center there is an accumulation of a histamine, serotonin, organic acids, increase in concentration of hydroxyl and hydrogen ions. Endotely of a peritoneum is exposed to dystrophic changes. Owing to an acute inflammation there is a formation of solderings between a peritoneum, bodies of a small pelvis, intestines loops, an epiploon, a bladder.
The current of a pelvioperitonit can be followed by an exudate congestion in a uterine pryamokishechnom space with formation Douglas abscess which break in a free abdominal cavity leads to development of the poured peritonitis. Pelvioperitonit is caused by colibacillus, staphylococcus, gonokokky, hlamidiya, a mycoplasma, viruses, anaerobe bacterias, and more often microbic associations - in the latter case its current accepts more difficult character.
Classification of pelvioperitonit
The clinical gynecology distinguishes secondary pelvioperitonit, caused by inflammatory diseases, and primary pelvioperitonit, developing at direct penetration of an infection into a cavity of a small pelvis.
Taking into account local prevalence allocate partial pelvioperitonit with the limited site of an inflammation near a source of an infection and diffusion, taking a parietal and visceral peritoneum of a small pelvis.
As the prevailing changes in a small basin of a pelvioperitonita are subdivided on adhesive (slipchivy, proceeding with formation of solderings) and ekssudativny (vypotny).
On character of inflammatory exudate pelvioperitonit can be serous and fibrous, hemorrhagic or purulent. Character of exudate at a pelvioperitonita depends on a type of activators or their associations. Staphylococcal pelvioperitonit is followed by a serous and purulent or purulent exudate; at bacillary flora exudate serous and purulent with a fetid kalovy smell. At virus and chlamydial pelvioperitonita inflammatory separated more often serous or serous and purulent; at a gonorrheal etiology - it is purulent - hemorrhagic.
Reasons of a pelvioperitonit
More often development of a pelvioperitonit is preceded by any infectious and inflammatory process in a small basin. In this case pelvioperitonit is secondary and serves as a complication of a sharp adneksit, a serous or purulent salpingit, purulent tubovarialny educations (a piovar, a piosalpinks), the suppurated zamatochny hematoma, genital tuberculosis, gonorrhea, a metroendometritis, appendicitis, a sigmoidit, intestinal impassability, etc.
Primary pelvioperitonit arises at direct penetration of microbic activators into a cavity of a small pelvis owing to perforation of a wall of a uterus at gynecologic operations and manipulations (installation of Naval Forces, surgical abortion, a diagnostic scraping), a metrosalpingografiya, gidro-and pertubation of uterine tubes, introduction to a uterus cavity for the purpose of termination of pregnancy of chemicals, damage of the arch of a vagina during obstetric operations etc. Pelvioperitonit quite often demonstrates against the background of decrease in the general resistance, stresses, periods, overcooling.
Symptoms of a pelvioperitonit
Development of a pelvioperitonit sharp: the disease begins with sharp increase of temperature to 39-40 °C, emergence of intensive pains in the bottom of a stomach, periodic oznob, tachycardia (to 100 and more . in min.), nausea, delays of gases, a painful urination, an abdominal distension. Objectively at a pelvioperitonita intoxication symptoms, the weakened vermicular movement, the dry, laid-over by a grayish raid language come to light. Positive signs of irritation of a peritoneum are more expressed in the lower departments of a stomach more weakly - in its top half.
A little more erased picture characterizes a current of a chlamydial pelvioperitonit. In this case the symptomatology accrues gradually, however there is a tendency to early formation of solderings. During diagnostics pelvioperitonit differentiate with peritonitis, a parametritis, piosalpinksy, appendicitis, extra-uterine pregnancy, reabrupt ovary tumor legs. To patients with suspicion on pelvioperitonit urgent hospitalization in a gynecologic hospital is required.
Diagnostics of a pelvioperitonit
About existence of a pelvioperitonit it can be suggested by the gynecologist on the basis of the anamnesis of the patient. The analysis of peripheral blood at a pelvioperitonita reveals the raised SOE, considerable with shift of a formula to the left, toxic anemia. Blood test on SRB gives sharply positive reaction.
At a palpation of a stomach tension of muscles of a stomach, the upper bound of inflammatory infiltrate in a small basin, positive peritonealny symptoms is defined. The Bimanualny vaginal research is followed by sharp morbidity in a uterus and appendages; because of an exudate protrusion of the back arch of a vagina, shift of a uterus of a kpereda and up is noted. Ultrasonography by the vaginal sensor allows to specify prevalence of an inflammation, to reveal existence of an exudate in a small basin. For an exception of sharp pathology in an abdominal cavity the survey X-ray analysis is carried out.
For the purpose of identification of microbic agents the bacteriological research of the separated vagina and the cervical channel, IFA-diagnostics is conducted. However, as microflora of a vagina can not reflect the processes developing in a small basin at a pelvioperitonita carrying out a diagnostic laparoscopy or puncture through the back arch of a vagina for an exudate intake is justified.
Treatment of a pelvioperitonit
At a pre-hospital stage before establishment of the diagnosis of a pelvioperitonit introduction of the anesthetizing medicines is contraindicated; as a measure of simplification of a state only applying of ice is allowed to a stomach bottom. Therapy of a pelvioperitonit complex, is directed to suppression of infectious process, removal of painful symptomatology and intoxication. According to indications surgical intervention is carried out.
In the sharp period of a pelvioperitonit the bed rest, rest, situation in a bed with the raised headboard, cold on a stomach is recommended. Taking into account the revealed microbic flora prescription of antibiotics of groups of semi-synthetic penicillin (amoxicillin, an oksatsillin), tsefalosporin (cefazolin, a tsefotaksim), ftorkhinolon (ciprofloxacin), macroleads, aminoglycosides, tetratsiklin, imidazoles (metronidazole), etc. is shown. Dezintoksikatsionny infusional therapy, introduction of plasma and plasma substitutes, proteinaceous hydrolyzates is carried out.
Courses of medicamentous therapy of a pelvioperitonit join antihistaminic, soothing also resolvents, vitamins. For restoration of a biocenosis of a vagina also bifidumpreparata are appointed lakto-. The good effect at a pelvioperitonita is reached by ultra-violet radiation of blood (UFOK). After subsiding of the sharp phenomena of a pelvioperitonit the physical therapy is carried out: ultrasound, electrophoresis, , microwave oven, UVCh, laser therapy, LFK, massage.
Medical punctures through the back arch of a vagina with evacuation of an exudate, introduction of antibiotics, anti-septic tanks are shown to patients with pelvioperitonity. At detection of purulent exudate for its evacuation carrying out a back kolpotomiya or laparoscopy with drainage of a cavity of a small pelvis and performing intra belly infusions is shown.
At suspicion on perforation of a uterus, a necrosis of tumoral knots, , , tuboovarialny abscess is made the emergency chrevosecheniye. The volume of a surgical grant in this case is defined by a clinical situation. At the complicated current of a pelvioperitonit the adneksektomiya, nadvlagalishchny amputation of a uterus with appendages, a hysterectomy (full removal of a body of a uterus), a pan-hysterectomy can be made (removal of a uterus with a neck and appendages).
Forecast and prevention of a pelvioperitonit
At competent and timely treatment of a pelvioperitonit the disease comes to an end with an absolute recovery. The best remote results in treatment of a pelvioperitonit are achieved at active tactics – carrying out punctures, a laparoscopy, drainage. In this case the percent of approach of the subsequent pregnancies is higher, than at conservative maintaining. After the postponed pelvioperitonit the patient can have infertility, pregnancy not incubation, development of extra-uterine pregnancy, recidivous inflammations, a syndrome of pelvic pains.
The exception of the factors leading to development of a pelvioperitonit requires preventive inspection at the gynecologist, timely treatment of genital infections, use of barrier ways of contraception, timely extraction of Naval Forces, performing preventive antimicrobic therapy after gynecologic operations, the prevention of the complications connected with abortions, childbirth, carrying out intrauterine manipulations.