Parametritis

Options - inflammation parauterine fiber. Pathogens - mostly Staphylococcus aureus or Escherichia, often the association of microorganisms. Infection of the uterus and appendages spreading lymphatic system. Very often parametritis developed with a combination of injury and inflammation of various parts of the genital organs (post-abortion cervical fractures, cervical and diathermocoagulation diatermoekstsiziya operating uterine injury or appendages). Inflammation usually captures certain areas from infiltration of the anterior neck extends along the lateral edges of the bladder to the anterior abdominal wall; from cervical anterolateral departments - to occlusive disease and the side of the abdomen; from cervical posterolateral divisions - to the walls of the pelvis; from the back of the neck department - to the rectum. The inflammatory infiltrate may disappear, fester or acquire chronic course.

Symptoms within. Persistent fever, acquiring with festering intermittent character. The general condition of the patient at the beginning of the disease have changed little, but the signs of intoxication are determined by the propagation process: pale skin, loss of appetite, weakness, headache. There are a dull pain and heaviness in the lower abdomen, a feeling of pressure in the rectum, sometimes dysuria, pain and difficulty in defecation. Indicators of blood to suppuration, as a rule, only a persistent and prolonged increase in erythrocyte sedimentation rate; with festering - in the case of pronounced leukocytosis sharp shift leukocyte left. Signs of peritoneal irritation are absent. When distributing infiltrate the walls of the pelvis its upper limit may be determined at the level of pupartovyh ligaments and midline - wedge toward the navel For percussion spinous processes of the iliac bones of the pelvis revealed dullness of sound, if infiltration reaches the pelvic wall (Gentera symptom). This technique is based on the difference of percussion tones helps to detect unilateral IPT bilateral lesion tissue. The characteristic data obtained by bimanual palpation, which determines the shortening and smoothing vaginal vaults, more severe or the place of destruction of the individual layers parauterine fiber (rear, front or sides) or on all departments arches in total distributing process. The uterus is not fully contoured, as wholly or partially included in the infiltrate.

Palpation in the early maloboleznenna disease but becomes painful with festering. The signs of change are festering general condition and identification of areas of softening infiltration. Complications: abscess breakthrough in the free abdominal cavity, rectum, urinary bladder. Differentiate need from the pelvioperitonita, acute inflammation of the uterus, torsion leg tumor of the uterus, and uterine necrosis nodes fibroids.

Treatment. In the acute stage of inflammation used antibiotics such as monomitsin, kanamycin, cephalosporin, coupled with sulfonamides (10% solution etazola 10 ml / 2 times a day). Taking into account the possible role of anaerobes in the development process, it is useful to apply for 5-10 days metronidazole (trihopop) of 0.25 g 3 times a day. It is advisable to introduce / in to 150 ml of a 3% calcium chloride solution dropwise; / m 10 ml 25% solution of magnesium sulfate, 1 times a day. Chill in the lower abdomen, pain relievers. When festering abscess is opened by the back colpotomy with the obligatory introduction of drainage T-shaped rubber tube for a few days. When you distribute an abscess to the borders of his pupartovoy ligament is opened from the abdominal wall (extraperitoneal). In the transition stage in acute and subacute chronic prescribed means to facilitate infiltration resorption: microclysters with 2% solution of potassium iodide, 50 ml of 1 times a day, a slight heat. With long-term existence of infiltration used corticosteroids, prednieolon 20 mg / day (total dose 400 mg). At full normalization of blood parameters - ultrasound on the abdomen. After 4-6 months after the onset of the disease is shown spa treatment with hydrogen sulfide irrigation, vaginal, rectal and vaginal mud tampons, massage (Matsesta, Khilovo, Pyatigorsk, Saki and other resorts). The disease is characterized by slow regression of inflammation.