Piovar – an abstsedirovaniye, extensive purulent fusion of tissues of ovary. Clinically it is shown by high fever, sharp belly-aches, allocation of putreform is more white, the dizurichesky and dispeptichesky phenomena. As complications can serve tuboovarialny abscess and pelvioperitonit. Diagnostics of a piovar includes carrying out a vaginal research, bacteriological crops, ultrasonography of a small pelvis, a diagnostic laparoscopy. Treatment of a piovar demands performance of an adneksektomiya on the party of defeat or an extirpation of a uterus with appendages with the subsequent antibacterial and recovery therapy (physiotreatment, mud cure, medical bathtubs).
Piovar develops at penetration of pathogens into ovarialny fabric in the intrakanalikulyarny, limfogenny or hematogenic way. The acute inflammation of a stroma of a cortical layer of an ovary leads to local disorder of blood circulation, I will swell, focal or diffusion inflammatory infiltration with the subsequent formation of abscesses of an ovary. Merge of purulent cavities promotes fusion of ovarialny fabric and transformation of an ovary into the meshotchaty education filled with pus – . Localization of a piovar usually unilateral.
As activators of purulent processes in ovaries serve aerobes (, staphylococcus, e. Coli, streptococci, gonokokk), anaerobe bacterias (peptokokk, bakteroida, peptostreptokokk), gramotritsatelny microorganisms (proteas, a klebsiyell) and their associations. Piovar can be spliced with basin walls, a pipe, a uterus, an epiploon, a bladder and loops of intestines. The break of a piovar in a free abdominal cavity and the next hollow bodies (a rectum, a bladder, a vagina), formation of tuboovarialny abscesses, development of a parametritis, a pelvioperitonita, the poured peritonitis is in rare instances possible.
Reasons of development of a piovar
In pathogenesis of a piovar the intrakanalikulyarny (ascending) way of infection from the genital and ekstragenitalny centers prevails; less often the infection extends gematogenno or limfogenno. Piovar usually is a complication of inflammatory diseases – a tservitsita, an endometritis, a salpingit, a salpingooforit, an ooforit.
Quite often formation of a piovar is preceded by carrying out various gynecologic operations: a vaginal hysterectomy, a resection of an ovary, a scraping of a cavity of a uterus, abortion (especially criminal abortions), Cesarean section, bandaging of uterine tubes, a salpingektomiya, a transvaginal puncture of follicles of ovaries at EKO, etc. Besides, existence of Naval Forces increases risk of development of a piovar and piosalpinks by 4 times. In some cases develops owing to a rupture of a cyst of a yellow body or a follicular cyst.
As Premorbidny background for development of a piovar conditions of an immunodeficiency, an endokrinopatiya (hyper - and a hypothyroidism, diabetes), somatic diseases (anemia, infections), social and behavioural factors (a stress, alcoholism, drug addiction, early or chaotic sexual communications), cystous educations can serve in ovaries, etc.
Symptoms of a piovar
The clinical picture of a piovar is characterized by an all-inflammatory syndrome, local inflammatory changes and intoxication. The clinic of a piovar demonstrates from rise in high temperature, gektichesky fever, a fever, perspiration, tachycardia, sharp weakness, a sleep disorder and appetite. In the bottom of a stomach the acute pulsing pain amplifying at any physical activity is noted during periods, defecation, sexual intercourse. Dizurichesky and dispeptichesky violations are characteristic; appear putreform bleach from a genital tract.
Against the background of a piovar and a piosalpinks the uniform inflammatory conglomerate – tuboovarialny abscess is quite often formed. At development of a pelvioperitonit symptoms of irritation of a peritoneum join.
Diagnostics of a piovar
Recognition of a piovar in gynecology demands an integrated approach: carrying out a gynecologic research, ultrasonography, bacteriological crops of dab on flora, a diagnostic laparoscopy. Information on the inflammations of internal genitals or the postponed gynecologic interventions which are available for the patient gives help in diagnostics of a piovar.
Shifts in the general blood test at a piovara are characterized leykotsitozy, acceleration of SOE (to 80 mm/h and above). The bacteriological research separated from a vagina allows to identify causative agents of an infection and to begin antibacterial therapy. The vaginal research promotes identification more often than the unilateral opukholevidny painful education having the dense capsule and indistinct borders because of an union with surrounding bodies (an epiploon, intestines loops, a bladder).
According to gynecologic ultrasonography it is visualized in the form of ekhopozitivny roundish education with non-uniform internal contents because of multiple inclusions, unevenly reinforced capsule (6-10 mm). In doubtful cases performance of a puncture of the back arch of a vagina, a diagnostic laparoscopy is required. Piovar during diagnostics differentiate with an acute appendicitis, cholecystitis, intestinal impassability, peritonitis, pyelonephritis, a sharp salpingooforit.
Treatment of a piovar
Treatment tactics which the modern gynecology applies at patients with piovary includes radical removal of the purulent center, suppression of infectious process, hospital and post-hospital rehabilitation. In the preoperative period antibacterial, anti-fungal, anti-protozoan means are appointed; carry out the dezintoksikatsionny therapy immunostimulating therapy (UFOK, VLOK), haemo sorption, a plasma exchange.
At a surgical stage removal is made it is purulent - the destructive center. Palliative interventions at a piovara (a kolpotomiya, an abscess puncture) are justified in case of high probability of perforation of an abscess in an abdominal cavity, its break in hollow bodies or at the general weight of a state. As radical intervention at a piovara at young women serves the unilateral ooforektomiya or an adneksektomiya – removal of the inflammatory changed ovaries or completely appendages in the laparoscopic or laparotomichesky way. At women in a postmenopause performance of nadvlagalishchny amputation or a hysterectomy with removal of appendages is considered optimum.
At a secondary pelvioperitonit and peritonitis after removal it is purulent - necrotic fabrics the prolonged drainage of an abdominal cavity with carrying out peritonealny dialysis is carried out. At a stage of rehabilitation physiotherapeutic courses are conducted: UZT, , microwave therapy, magnetotherapy, electrophoresis, laser therapy, mud cure, hydrosulphuric bathtubs and so forth.
Complications of a piovar
At perforation of a piovar and izlitiya suppurating purulent peritonitis develops in an abdominal cavity. At depletion of an abscess the inflammation (rektit, sigmoidit, cystitis, a colpitis) develops in hollow bodies, adjacent to a piovar, – a direct or sigmovidny gut, a bladder, a vagina in them, are formed is long not closed fistulas. The current of a rektit and a sigmoidit is characterized by tenezma, releases of slime, a ponosama. At cystitis painful and frequent desires to an urination develop; vaginit it is shown by purulent allocations from a genital tract.
Forecast and prevention of a piovar
In case of intensive and in time the begun treatment of a piovar the forecast is favorable for life. Safety of reproductive function, even when performing of the sparing intervention, can be limited further in view of development of cicatricial and adhesive processes in a small basin.
Prevention of formation of a piovar consists in timely treatment of genital infections, rational use of intrauterine contraception, the prevention of complications after gynecologic interventions, preventive observation at the gynecologist.