Parametritis

Parametritis is the nerve okolomatocnah fiber (parameters). Occurs as a result of penetration into it (usually through the lymph system) streptococci, staphylococci and other microorganisms. Parametritis occurs mostly after childbirth and abortion (especially community-acquired).
Parametritis can develop when the paraproctitis, appendicitis, diseases of the uterine appendages, common infectious diseases, as well as after intrauterine manipulations and operations on the internal genitals.
There are parametritis: front, when the inflammation extends towards the bladder, the back - side of the rectum, side - inflammation is located in one of the lateral parts of the pelvic fiber.
Parametritis always accompanied by fever, sometimes with chills. Depending on localization and distribution process disturbed activity of adjacent organs.
Diagnosis of parametritis is based on historical data and results bimanual vaginal research infiltrate easily palpated, different density and homogeneity).
Frequent complication of parametritis is the formation of abscesses pelvic tissue. The abscess may be opened in the rectum, bladder and lead to the formation of a fistula, at least - of sepsis.
Treatment of parametritis conservative. In the acute period of bed rest, ice on my stomach, antibiotics (by a physician) and symptomatic treatment; in subacute and chronic stages apply physiotherapy and Spa treatment; in the formation of an abscess surgery is shown.
Cm. also of Parametri.

Parametritis (parametritis; from the Greek. para - around and metra - uterus) - diffuse nerve okolomatocnah fiber (cellulitis), located between serous pieces of the broad ligament of the uterus. Inflammation of the whole tissue of the small pelvis should be called pelvocalyceal.
The etiology and pathogenesis. Parametritis caused by an infection, usually spreads via the lymphatic vessels of the primary tumor. Pathogens: pyogenic stafilo - and streptococci, much less Escherichia coli, pneumococci, and anaerobes. Gonorrhea cause P. only in exceptional cases, when mixed or secondary infection. Parametritis occurs mostly after childbirth and abortion (especially community-acquired). Often P. develops in diseases of the uterine appendages (secondary P.), more often it is observed after surgical interventions (sounding of the uterus, the extension of the neck, scraping, biopsy and others)carried out without due asepsis. Sometimes the source of infection are the intestine (appendicitis, sigmoidit, paraproctitis), cystitis, pelvis. P. may develop in the treatment of radiant energy cervical cancer.
The clinical picture. There are the following stages of development P. Initial stage is characterized by redness, increased blood and lymphatic vessels, the emergence and progression of edema. Observed temperature increases of up to 39 degrees and more, sometimes once chills, increased heart rate in full compliance with temperature, slight pain, pain in the study. In the study through the vagina affected tissue seems testovaty, thick, resistant.
Stage infiltration and exudation: temperature stays and pulse Ochsen. Blood counts, blood sterile, minor abdominal pain (when moving, pressure, and tenderness to palpation. When vaginal examination (compulsory rectal exam!) in the area of diseased tissue nemopilema dense exudate, resp. infiltrate, shifting the uterus in the opposite direction and up. Infiltrates large size squeeze the bladder and rectum. Around inflammatory focus is formed by granulation shaft, blocking the way of infection. Localization, inflammatory exudate depend on anatomic correlations (see Parametri) and from the entrance gate, through which penetrated infectious agents. The mobility of the mucosa in the area of contact with the inflamed tissue is limited, the folds of her smooth.
Stage seal of the exudate: the resulting inflammatory exudates rich fibrin, which soon drops out. On the place of the granulation of the shaft is a powerful capsule, firmly demarcates the inflammatory process. The consistency of the exudate is reminiscent of the fibroids. When compressed infiltration bladder observed frequent urination, tenesmus, while squeezing the rectum difficult defecation.
The final stage. In most cases the exudate resolved; may remain only a small seal (residual infiltration), but there are cases when the exudate has purulent. These cases are accompanied by remitting temperature (suppurative fever), rapid pulse, chills, in the blood was neutrophilic leucocytosis. Lymphatic vessels are filled with pus, separate ulcers, merging, form parametricheskii ulcer. Sometimes the ulcer becomes spilled flegmonas inflammation throughout the pelvic fiber. In other cases the abscess breaks through into the rectum (most often), the bladder, the vagina, into the abdominal cavity (rare), to the buttocks (through sciatic hole), femoral triangle.
At the break of pus in the rectum marked tenesmus, the discharge of mucus and blood-tinged discharge. Perforated ulcer in the bladder is accompanied by symptoms of cystitis.
If pus paves the way through the outer skin, on the plot there are redness, swelling and sibline.
After the breakthrough of ulcer process usually runs favorably. A breakthrough in the bladder is prognostically more severe (the threat of pyelonephritis).
In some cases of purulent process after the break lasts for a long time, the formation of fistulas, leakages, the General condition of the patient deteriorates, growing depletion and, if time will not be rendered corresponding operational assistance, you may develop amyloid rebirth parenchymatous organs with all the ensuing consequences.
There are the following forms of parametritis. Acute septic parametritis (septic cellulitis) is characterized formidable common signs of sepsis. On the 3-4th day after childbirth or miscarriage rapidly evolving picture of severe disease (temperature up to 40 degrees, rapid pulse, often immediately receive an alarming the intersection of the temperature curve curve heartbeat, insomnia, prostration, language dry, lined). In these cases, exudation parametrium a bit. The prognosis is poor; therapy - see Sepsis.
Front parametritis - inflammation of tissue within the front of u uteri - is rare. The entrance gate infection - damage to the anterior wall of the cervix of the uterus and the bladder mucosa, accidental damage in the area of the front of the vaginal vault. This form of parametritis can develop after some surgeries (vaginal and urethrovesical caesarean section). The effusion may go reveillee space and from there into the tissue of the anterior abdominal wall, forming a flat seal. Pus may break (rarely) in the bladder, vagina, peritoneal cavity (peritonitis) and, as an exception, in pubic joint.

Right purulent parametritis. The process involved a m. psoas with the formation of contractures of the lower limbs.

Side parametritis - inflammation of the tissue wide uterine ligaments - occurs most often forms (70-80%). If the infection goes from the front to the side wall of the cervix from the corresponding fornix, inflammatory exudate wide strip goes to side, up and forward, in the direction of the round uterine ligaments, spreading in a wide infiltrate on the side of the pelvis and over the inguinal ligament (the so-called abscess Dupuytren). In primary localization of infection in posterolateral parts of the cervix or in the side arches vagina exudate usually extends to the back of the parametric part of the retina, reaching the walls of small and then the great basin, where, going behind the rectum (resp. sigmoid), rises up to the kidneys, forming here parametricheskii or even subphrenic abscess (see). With the involvement of the large lumbar muscle may develop psot. (see) with the formation of contractures of the lower limbs (Fig.).
Side parametritis divided into upper and lower; way of distribution of pus and output it out, see Parametri.
Back postpartum parametritis is extremely rare; some authors deny its existence as an independent form. An entrance gate for the infection are inflammatory processes of the rear wall of the cervix, rectum and Douglas pocket (purulent erosion, the Cathars cervix, accidental damages during obstetric and gynaecological operations).
In most cases the disease from the beginning takes sluggish torpid character without high temperature and education inflammatory exudates.
Often the rear parametritis occurs in combination with chronic intraperitoneally inflammation in the area of red pocket. As a result of this inflammation is wrinkling, seal and shortening Sacro-uterine ligaments. The clinical picture of the disease at the forefront are the excruciating pain in the rump and lower back, painful coitus, algodysmenorrhoea, painful defecating.
A clinical syndrome type rear P. considered as a private demonstration of vegetative dystonia.
Clinical symptoms of chronic back parametritis may be similar to the symptoms of endometriosis (see).