Pelvioperitonit

Pelvioperitonit is an inflammation of the peritoneum of the small pelvis.
Etiology and pathogenesis. Pelvioperitonit may be a manifestation as septic and gonorrheal infections; less pelvioperitonit develops when the urogenital TB. The disease is possible after abortion, childbirth, and as a consequence of transition of the inflammatory process of the uterus or breakthrough purulent inflammatory formations of the uterus into the abdominal cavity. When the metroendometrit infection on the pelvic peritoneum spreads through lymphatic system. For gonorrhea is more common way of spreading through the fallopian tube. Inflammation of the peritoneum is accompanied by formation of serous, sero-fibrinous or purulent exudate. Exudate in gonorrhea contains a lot of fibrin, which prevents further spread of pathologic process, causing adhesions between the intestine, gland and pelvic organs.
Over and symptoms. Beginning of the disease is acute: vomiting, a sharp rise in temperatures, frequent heartbeat, nausea, possible vomiting, abdominal pain, dry, coated tongue, stool retention. When pelvioperitonit the General condition of patients suffered less, than in diffuse peritonitis (see). It is important to exclude diffuse peritonitis, which is an indication for surgical intervention. At a palpation of the abdomen there has been a sharp pain, phenomena muscle protection and positive symptom Shchetkina - Blomberg only in the lower abdomen. Vaginal examination at the beginning of the disease because of the sharp pain and tension of the muscles of the anterior abdominal wall does not provide sufficient objective data. The difficult situation of the patient in the future is somewhat better: disappear nausea, vomiting, dry language, the pulse becomes less; on the border of the inflammatory infiltrate formed transverse groove, sometimes clearly visible during inspection of the abdomen of the patient. When the vaginal or rectal studies in premonicion-uterine space can be detected effusion and often bulging posterior vaginal vault. Effusion shifts the uterus up and toward the front. The upper boundary of the effusion palpation is located above the womb. It is formed at the expense propavshaya loops of intestine and is easily installed on the characteristic of tympanic percussion sound. Effusion, determined by the dullness of percussion sound is somewhat lower. Consequently, when pelvioperitonit can see significant discrepancy between the upper (palpation) and lower (percussion) border infiltration.
In most patients under the influence of therapy, gradual improvement of General condition, the temperature is reduced. The course is usually protracted. Started improving, can be replaced by deterioration. On the place of resorbed effusion appear spikes. In the result of adhesions is the offset of the pelvic organs, the violation of their functions, pain - all this leads to reduced work capacity. Sometimes the temperature gets remitting nature in connection with suppuration of the exudate (see Douglas abscess).
Treatment. If you suspect pelvioperitonit the patient should be hospitalised immediately accompanied by a nurse or midwife. Before transportation should not be injected with painkillers that can change the clinical picture and make the final diagnosis. In the hospital prescribed a strict bed rest, mechanically and chemically light diet, vitamins, analgesics (promedol, candles with belladonna and others), injected calcium chloride. Used by prescription antibiotics (penicillin, streptomycin, tetracycline with nystatin and other). To combat dehydration and acidosis injected isotonic sodium chloride solution with 5% glucose solution to 2-2,5 l per day. When paradicsom state bowel shows the use of hypertonic enemas with the subsequent introduction of the gas discharge tube. In the first two days of the disease locally using an ice pack. The patient needs special care.
Prevention of pelvioperitonit is early diagnosis and effective treatment of gynecological diseases.

Pelvioperitonit (pelviperitonitis; from lat. pelvis - to-pelvis and Greek. peritonaion - peritoneum; synonym peritonitis pelvis circumscripta) - inflammation of the peritoneum of the small pelvis.
Etiology. Pelvioperitonit occurs a second time on the soil of primary inflammatory process of the uterus, fallopian tubes, ovaries or pelvic fiber septic, gonorrhea, or tubercular etiology. Pelvioperitonit tubercular etiology may occur when the intestinal tuberculosis, mesenteric glands or metastatic by other bodies affected by tuberculosis. Sometimes P. develops on the grounds of acute appendicitis. To develop pelvic peritonitis may cause perforation of the uterus when it is scraping, damage to the posterior vaginal fornix for obstetric operations, sometimes getting chemical substances (hysterosalpingography)and sub coitu.
P. may occur at break or of Microperforation of pyosalpinx or abscess fiber of small pelvis and hit pus in the abdominal cavity.
Most often P. develops the spread of the inflammatory process of the uterus and its appendages on the peritoneal covers these bodies. In this case we speak about perimetric (inflammation of peritoneum, covering the uterus) and periodicity (inflammation of the abdominal cover of the uterus). If at this stage the inflammatory process is not docked, it may spread to a large part of the pelvic peritoneum, or even for the whole pelvic peritoneum.
Pathological anatomy. Pathogens cause inflammation of the peritoneum of the small pelvis with the formation of the effusion. Thus the peritoneum sharply hyperemic, infiltrated, often with fibrinous-purulent bloom. At the beginning of the disease effusion, accumulated in dopasowa pocket, muddy, and then can purchase purulent. If the process has no tendency to delimitation, pelvioperitonit can go to diffuse diffuse peritonitis - inflammation throughout the peritoneum.
Pelvic peritoneum compared with the peritoneum of the upper floors of the abdominal cavity is less suction capability and conditions topography prevent mechanical stiffness of exudate in the direction of the small pelvis to the diaphragm. Therefore, P. under other equal conditions is more favorable, than peritonitis any other abdomen, rarely goes in diffuse peritonitis and is less intoxication. However, the inflammatory process in small pelvis not pass unnoticed for the whole of the peritoneum, which in varying degrees, is developing a reactive inflammation. This initial phase of pelvioperitonit referred to as an open stage. With good resistance and correct treatment of the inflammatory process is beginning to ogranichivatsya in the pelvic area, that is transformed into the so-called closed stage. Packing and loops of intestine, spavace among themselves, form a kind of a shaft, above which the process is not applicable. In this stage, P. might be causing abscess formation, red space (SEE Douglas abscess).


Over and symptoms. To start, open, stage during acute pelvioperitonit there was a sharp pain in the abdomen, especially in the lower divisions, nausea, vomiting, stool retention and gases. Observed temperature rise to high numbers. Pulse Ochsen, but corresponds to the temperature. The facial skin is often hyperemic. Language dry, lined. Belly slightly swollen, especially in the lower sections where you can define your muscles and symptoms of peritoneal irritation (Shchetkina - Blomberg and others). Palpation of the abdomen and percussion him (especially in the lower part) is called acute pain. The intensity of these symptoms decreases in the direction from the pubis to the epigastrium. Intestinal peristalsis weakened, but, as a rule, is bugged. Blood high leukocytosis, accelerated ROHE and shift the formula of white blood left. Vaginal examination in acute P. in the initial stage of the disease in connection with pattern of acute abdomen difficult. Sharp pain when moving the cervix, sharp pain and tension posterior vaginal fornix. Further you can define effusion in premonicion-uterine deepening and protrusion of the posterior vaginal fornix. Sometimes vaguely outlined painful uterus and thickened painful appendages.
When pelvioperitonit gonorrheal etiology General condition of patients better than described, but the abdominal tenderness are much stronger.
Under favorable for quickly comes delimitation process and improving the General condition of the patient, but local tenderness to palpation of the lower abdomen is kept for a long time. Usually for P. long. Started improving, can be replaced by deterioration. On the place of resorbed effusion appear multiple adhesions formed chronic adhesive., In the result of adhesions is the offset of the pelvic organs, the violation of their functions, pain - all this leads to the decrease of work capacity.
Complications. If the result P. an abscess has formed red space and the abscess is not opened, he can break into the rectum, bladder, vagina or the abdominal cavity. Before the breakthrough of the ulcer in a patient intestines appear tenesmus, from the rectum mucus is secreted. After draining the abscess faeces pus. Breakthrough ulcer in the bladder causes pus in the urine and often to the emergence of an ascending urinary tract infection. After draining the abscess is a condition of the patient improves. Breakthrough same ulcer in the abdominal cavity leads to razlitom peritonitis.
The diagnosis. Acute pelvioperitonit must be differentiated with diffuse peritonitis, acute appendicitis and ectopic pregnancy. For acute P. characterized by the absence picture of the overall poor condition, very frequent heartbeat, persistent vomiting, spilled pain around the abdomen, the observed with diffuse peritonitis. In the differential diagnosis of acute appendicitis important beyond history, have blood picture (significant increase in the RBE in P.) and the nature of irradiation of pain. From ectopic pregnancy P. distinguish characteristic features of history. Crucial diagnostic puncture back arch.
Treatment depends on the stage of the disease and its cause. When P. caused acute salpingitis or adnexitis, treatment, according to the main disease, should be continued. First, it must be conservative, aimed at limiting the inflammatory process and the formation of adhesions. Strict bed rest, ice on the lower abdomen, the position of the upper body should be slightly elevated. Bimanual vaginal studies should be to limit and to conduct them carefully. Of drugs prescribed antibiotics (300 000 UNITS of penicillin 6 times and 500 000 IU streptomycin 2 times a day with nystatin). Intravenous drip by injected with saline or 5% glucose solution-1500-2000 ml or more (depending on the severity of the disease with vitamins C and complex Century. Very good therapeutic effect of intravenous drip blood-150-200 ml
To reduce pain using candles with belladonna, antipyrine, promedol, pantopon. In severe cases, you should assign heart funds (camphor, caffeine, kordiamin, etc). When events paresis bowel injected hypertension (10%) sodium chloride solution, neostigmine and put hypertensive or siphon enema.
When fluctuations, flattening or protrusion of the posterior vaginal fornix do puncture back arch. Having pus, taking it for sowing to determine the cause of disease, and to determine antibiogramme and produce back colpotomy (see). Through colpotomy hole insert rubber drainage tube, which in the abdominal cavity administered antibiotics. When perforated P. or peritonitis (breakthrough pus from pyosalpinx, festering ovarian cyst or abscess fiber of small pelvis) shows urgently chrevosechenie and destruction of purulent with subsequent extensive drainage of the abdominal cavity, preferably through the rear arch (rear colpotomy) and anterior abdominal wall.
If pelvioperitonit has ogranichilisj, that is passed into the so-called closed stage, then continue anti-inflammatory treatment, as in inflammatory diseases of genitals in acute and subacute stages (see Adnexitis, Parametritis). When crossing the disease into a chronic stage with the formation of multiple adhesions recommend physical therapy and gynaecological massage under strict temperature control, blood and the General condition of the patient. Initially, apply inegalitatii (iontophoresis) with iodine and potassium or calcium chloride, and then gradually go to the thermal procedures: physiotherapy, diathermy, inductothermy, mud and paraffin treatment, etc.
Prevention P. is the prevention of inflammatory gynecological diseases. Cm. also Peritonitis.