Abscesses of the abdominal cavity
Abscesses of the abdominal cavity (Douglas space, sub-diaphragmatic, intercellular spaces) are the outcome of diffuse forms of peritonitis. They are usually polymicrobial, and more often there is a combination of aerobic microbial associations (E. coli, streptococci, proteus idr.) And anaerobes (bacteroides, clostridia, fusobacteria, etc.). Intraperitoneal abscesses can be single and multiple.
Symptoms, course. Initially, the symptomatology is unclear: usually again a rise in the temperature of intermittent or hectic character, combined with chills and tachycardia. Frequent symptoms are paralytic intestinal obstruction, local muscle strain of the anterior abdominal wall, lack of appetite, nausea. The intensity of symptoms depends on the size of the abscess, its location, the intensity of antibiotic therapy. Muscle tension and pain are usually more pronounced with abscesses located in the mesogastrium (close to the anterior abdominal wall); Subdiaphragmatic abscesses give less pronounced local symptomatology. In the blood, leukocytosis is found with a shift of the formula to the left. With a review of fluoroscopy of the abdominal cavity, it is possible to detect the level of fluid in the cavity of the abscess with gas above it. Contrastive examination of the gastrointestinal tract can reveal displacement of the intestine or stomach by infiltration.
If the abscess is caused by the inconsistency of the sausage-type joints, it is possible that the contrast material enters the cavity of the abscess from the intestinal lumen. In the diagnosis of abscesses of the abdominal cavity the leading role is played by ultrasound scanning of the abdominal cavity, computer X-ray tomography. Ultrasonic examination is especially indicated when the abscess is located in the upper part of the abdominal cavity.
Treatment depends on the location of ulcers and their number.
Subdiaphragmatic abscesses arise as a result of surgical interventions on the stomach, duodenum, gall bladder and bile ducts, with rupture of liver abscesses. Left-sided abscesses are more often caused by complications after splenectomy, pancreatitis, inconsistent sutures after gastrectomy and proximal gastrectomy. Fewer rarely subdiaphragmatic abscesses, especially right-sided abscesses, are caused by accumulation of residual pus after treatment of diffuse peritonitis. In this case, the suction action of the diaphragm is important.
Symptoms, course. Pain in the hypochondrium with irradiation in the scapula or the shoulder (Kehr's symptom); The patient walks, bending to the sore side, supporting the area of the hypochondrium with the hand. When palpation is determined by the rigidity of the muscles of the upper abdominal wall and tenderness along the intercostal spaces in the zone of localization of the abscess. With a forward disposition of the abscess, the pain syndrome is more pronounced. With a prolonged course, there may appear pasty and bulging of the intercostal spaces, respectively, the localization of the abscess, a pronounced soreness in this area. At X-ray examination - high standing and limitation of mobility during breathing of the dome of the diaphragm, in lung-atelectasis, pneumonic foci in the lower segments of the lung, fluid in the pleural cavity. In the abdominal cavity, it is possible to detect the level of fluid under the diaphragm, the displacement of neighboring organs by an abscess.
Treatment operative - opening and draining the abscess. When choosing an access, the precise localization of the abscess matters. With anterior subdiaphragmatic abscesses, an extraperitoneal dissection of the clitoris is performed along the course of the costal arch. They reach the transverse fascia, exfoliate it to the softening zone and open the abscess. The cavity is washed and drained with double-lumen drainage for active aspiration with washing. With posterior localization, extrapleural access is used on the bed of the XII rib after its excision.
Complications: sepsis, abscess penetration into the free abdominal or pleural cavity.
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Prostate adenoma
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenial diverticulum
- Epiphrenial diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Cholelithiasis
- Urinary retention acute
- Zollinger-Ellison syndrome
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Mediastinitis
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Perforated ulcer
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
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