– the closed congestion of purulent exudate in a gleam of a fallopian pipe owing to an obliteration of its uterine and ampulyarny part. it is characterized by pains in the lower departments of a stomach, the increased body temperature, it is frequent – signs of a sharp stomach. The diagnosis of a piosalpinks is established by means of a vaginal research, ultrasonography, OUSE-gisterosalpingoskopii, punctures of the back arch of a vagina, a diagnostic laparoscopy. Treatment of a piosalpinks quick – opening and sanitation of a fallopian pipe or a tubektomiya. At a piosalpinksa intensive antibacterial and dezintoksikatsionny therapy is carried out, then – physiotreatment.
most often is an outcome of a sharp salpingit (salpingooforit). Inflammatory changes lead to an obliteration (zarashcheniye) of a uterine and fimbrialny part of a fallopian pipe with education in it the closed meshotchaty cavity filled with purulent contents. At a piosalpinksa of a wall of a uterine tube stretch and thickened, mucous it atrophies gradually and replaced with granulyatsionny fabrics. The Ampulyarny part of a uterine tube is usually spliced with the next bodies – an epiploon, an ovary, intestines loops, a uterus body, forming with them a uniform inflammatory conglomerate.
Purulent secret of a piosalpinks in the beginning the liquid, containing virulent microorganisms; over time can become dense and aseptic. When involving in process of an ovary in it abscess is formed, and at purulent fusion of ovarialny fabric – which can merge with piosalpinksy in a uniform cavity - tuboovarialny abscess.
Proteolytic effect of pus on the capsule is followed by perforation of a piosalpinks. At a rupture of walls of a piosalpinks pus can stream in a rectum, a bladder, the vagina with education is long not healing pipe and intestinal, pipe or pipe and vaginal fistula; sometimes the break of an abscess happens in a free abdominal cavity and a cavity of a small pelvis to development of diffusion peritonitis or a pelvioperitonit.
Reasons of development of a piosalpinks
As the reason of a piosalpinks serves penetration of infectious agents into a uterine tube with development in it a septic inflammation. Most often at a piosalpinksa streptococci, colibacillus, staphylococcus come to light, gonokokk, hlamidiya, mycoplasmas, mikobakteriya of tuberculosis, a protea, a klebsiyella, an enterokokka which act separately or form microbic associations.
Activators get to appendages in the ascending way - from a vagina, the tservikalny channel, a uterus body; sometimes get in the hematogenic or limfogenny way (at tuberculosis). Infection often develops after surgical abortions, diagnostic vyskablivaniye, spontaneous termination of pregnancy, childbirth; quite often leads to development of a piosalpinks salpingit or adneksit a gonokokkovy or septic etiology. Use of Naval Forces, periods, decrease in reactivity of an organism contributes to formation of a piosalpinks.
at a septic infection has unilateral localization, at gonokokkovy more often - bilateral. On character of a current can have sharp or chronic character.
Symptoms of a piosalpinks
The clinic of a piosalpinks is characterized by the holding apart, pulsing pains in the lower departments of a stomach and, especially, on the struck party. Pains often irradiate in a waist, a sacrum, the lower extremity, inguinal area.
High fever from an oznobama which is replaced by the periods of a subfebrilitet is characteristic. Symptoms of intoxication, deterioration in health, an indisposition, weakness, perspiration, tachycardia are noted. Nausea, the dispepsichesky and dizurichesky phenomena, a delay of a chair and an otkhozhdeniye of gases can be observed. Piosalpinksu quite often accompanies violation of menstrual function, emergence serous and purulent or purulent separated from a genital tract. In chronic cases of a piosalpinks of pain have changeable stupid character, amplify after overcooling, sexual intercourse, physical effort, periods.
By the heaviest current it is characterized , the caused septic flora, especially in association with staphylococcus and E. coli. Differs in less bright clinic and more long character of a current , the caused gonokokkam, in mycoplasmas, a chlamydial infection. In case of development of a pelvioperitonit or the poured peritonitis signs of a sharp stomach appear: skhvatkoobrazny pains, symptoms of muscular protection, vomiting, dryness and oblozhennost of language, etc.
Diagnostics of a piosalpinks
Data of the anamnesis, gynecologic, laboratory and tool researches allow to differentiate from an acute appendicitis, cholecystitis, pyelonephritis, the complicated ovary kistoma. In the course of the bimanualny vaginal research in the field of the struck appendage the painful opukholepodobny education which does not have accurate contours is defined. At a bilateral piosalpinks the increased uterine tubes can occupy all cavity of a small pelvis; the uterus at the same time is not defined or konturirutsya with great difficulty. At a palpation the fluctuation centers are felt. For specification of the diagnosis of a piosalpinks the puncture through the back arch of a vagina is carried out.
According to transvaginal ultrasonography or transabdominal ultrasonography of a small pelvis behind a uterus the expanded fallopiyeva a pipe of a non-uniform ekhogennost decides on a fine suspension. The research of peripheral blood reflects an inflammation picture: , shift in the leykoformul to the left, increase of SOE, positive test for SRB. Bacteriological crops of dab on microflora are made for definition of infectious activators.
Among additional researches which are applied by gynecology at a piosalpinksa of the most informative the diagnostic laparoscopy allowing to define the nature of process, its localization, existence of an exudate and solderings in an abdominal cavity is. Besides, the laparoscopy can be carried out with the medical purposes – aspirations of purulent contents, local introduction of antibiotics. At perforation of a piosalpinks in hollow bodies consultation of the urologist, proctologist, performance of a tsistoskopiya, ultrasonography of a bladder, a rektoromanoskopiya can be required.
Treatment of a piosalpinks
Identification of a piosalpinks demands hospitalization of the patient in a gynecologic hospital. Treatment of a piosalpinks exclusively surgical in combination with the antibacterial, dezintoksikatsionny, immunostimulating therapy.
Surgical tactics is defined by age of the patient and character of a piosalpinks. At young women in need of preservation of a fallopian pipe the salpingostomiya - performance of an aim puncture of a piosalpinks with aspiration of contents and sanitation of a cavity of an abscess by antiseptics, antibiotics, enzymes is preferable. Punctures carry out through the back arch of a vagina under OUSE control by a course from 3-5 procedures, every other day.
Opening of fimbrialny department of a pipe (tubotomiya) at a piosalpinksa can be also executed in process of a laparoscopy. Among other things, the laparoscopy allows to execute lysis of solderings, opening of purulent education, sanitation or drainage of an abdominal cavity, intra belly infusion of medicinal solutions.
In the absence of effect of a salpingostomiya, need or a possibility of preservation of a uterine tube the tubektomiya from one or both parties is made; at a tuboovarialny purulent tumor – removal of appendages (adneksektomiya). In the complicated cases at a piosalpinksa removal of a uterus – performing nadvlagalishchny amputation or a hysterectomy with appendages can be required.
In the post-operational period for prevention of formation of hems and solderings carrying out an autogemoterapiya, Ural federal district, an electrophoresis, ultrasound, laser therapy, a magnotolazeroterapiya, paraffin, ozokeritovy or mud applications is shown. Performing gynecologic, segmentary, pointed, vibration massage, a balneoterapiya is possible.
Forecast and prevention of a piosalpinks
At a piosalpinksa the forecast can be burdened by violation of a menstrual cycle, development of a resistant form of infertility, increase in probability of extra-uterine pregnancy. When planning pregnancy repeated laparoscopic treatment with restoration of a gleam (reokklyuziy) and subsequent assessment of passability and a functional condition of uterine tubes (a gisterosalpingografiya, UZGSS) usually is required.
Prevention of a piosalpinks in gynecology dictates need of timely treatment of salpingit, STD exceptions (gonorrhoeas, clamidiosis, mycoplasmosis, etc.), preventions of abortions, post-operational and postnatal complications.