Treatment of pelvioperitonitis in gynecology

Treatment of pelvioperitonitis in gynecology

24.05.2022 0 By admin

Pelvioperitonitis is a secondary inflammatory process of the pelvic peritoneum caused by various gynecological diseases, such as adnexitis, metritis, endometrial inflammation, etc. Depending on the cause and nature of the inflammation, an individual treatment regimen is selected. If the cause is the development of pathogenic microflora, then antibiotics are prescribed. As an additional therapy, ultraviolet blood irradiation, ultrasonic exposure to the abdominal organs, electrophoresis, phonophoresis can be used. If the course of the disease is severe, then they resort to surgical intervention.

pelvioperitonitis

Pelvioperitonitis is accompanied by pain in the abdomen

Main characteristics

With pelvioperitonitis, the inflammatory process develops rapidly. Against the background of pathology, a local reaction occurs inside the pelvic cavity. The disorder of microcirculation begins, the permeability of the vascular bed increases, blood components leave the walls of the capillaries: albumin, fibrinogen, leukocytes. As a result, a serous or purulent secret is formed that accumulates in the abdominal cavity.

An acute inflammatory process leads to the accumulation of hydrogen ions, organic acids, serotonin, histamine in the lesion. The inner surface of the peritoneum undergoes dystrophic changes. In the absence of help, adhesive disease of the small pelvis occurs, in which thin films form between the internal organs and intestinal loops. As a result, the main function of the organs is disrupted and a complication develops – diffuse peritonitis.

Classification

In gynecology, primary and secondary pathological processes are distinguished. With the primary cause, infection of the tissues of the abdominal cavity with pathogenic microorganisms – bacteria and viruses. Secondary inflammation occurs due to diseases of the pelvic organs – salpingo-oophoritis, inflammation of the uterus, ovaries, bladder and other departments.

Based on the localization of the inflammatory process, we can distinguish:

  • limited pelvioperitonitis – affects a certain segment of tissues;
  • diffuse – involves the entire inner surface of the small pelvis.

Given the changes occurring in the body of a woman, the pathology is divided into:

  • adhesive – characterized by the formation of thin films between the organs, their adhesion and displacement from the normal anatomical location;
  • exudative – accompanied by the formation of accumulations of pus and exudate in the abdominal cavity.

The composition of the exudate formed during the inflammatory process depends on the pathogen.

in gynecology

In gynecology, pelvioperitonitis is divided into primary and secondary

Reasons for development

Most often, the pathology has a secondary form and occurs due to inflammatory processes in the small pelvis:

  • adnexitis;
  • metritis;
  • inflammation of the endometrium;
  • hematoma in the retrouterine space;
  • suppuration of the fallopian tubes;
  • hydrosalpinx;
  • genital tuberculosis;
  • parametritis.

Less commonly, the disease develops in the primary form. The causes of such inflammation are pathogens that penetrate the surface of the abdominal cavity under the following circumstances:

  • perforation of the body of the uterus during medical and diagnostic manipulations;
  • ovarian apoplexy;
  • perturbation of the fallopian tube;
  • surgical interventions with open access;
  • non-compliance with the rules of asepsis during laparoscopy;
  • cesarean section.

A relapse of inflammation can occur against the background of a decrease in the body’s resistance: during menstruation, pregnancy, hypothermia, taking certain medications. Postpartum relapse is not uncommon.

Characteristic features

It is impossible not to notice or ignore the inflammatory process. The following symptoms are rapidly increasing in a woman:

  • hyperthermia, accompanied by an increase in temperature up to 41 degrees;
  • severe unbearable pain in the lower abdomen;
  • an increase in heart rate to 150 or more beats per minute;
  • chills;
  • trembling in the body;
  • the appearance of sticky cold sweat;
  • nausea and vomiting that does not bring relief;
  • increase in the volume of the abdomen;
  • flatulence;
  • constipation;
  • intoxication of the body;
  • dehydration with characteristic signs – dry tongue, sunken eyes.

With postpartum inflammation of the peritoneum, a woman notes that discomfort is more common in the lower abdomen. The upper sections, as a rule, remain calm.

For signs of an infectious form, if the disease is chronic and caused by chlamydia, a sluggish course is characteristic. However, in this case, the risk of formation of adhesive process is high.

treatment

Treatment of pelvioperitonitis often requires surgery

Diagnostics

Signs of inflammation of the inner lining of the abdominal cavity are similar to manifestations of other life-threatening conditions. Therefore, with this clinical picture, differential diagnosis is required.

  1. A blood test shows an increase in the erythrocyte sedimentation rate, which indicates an active inflammatory process. There are signs of toxic anemia and leukocytosis.
  2. An analysis for C-reactive protein shows a positive result.
  3. When probing the abdominal wall, its tension is detected. There are characteristic symptoms of the inflammatory process inside the abdominal cavity.
  4. Gynecological examination causes pain in the patient. With the help of palpation, it is possible to determine the localization of the accumulation of exudate and the position of the uterus.
  5. Ultrasound scanning provides complete information about the state of internal organs. With the help of the study, the localization of the inflammatory process is detected, and pathologies similar in symptoms are excluded.

To clarify the causes of the disease during the examination, it is advisable to perform an analysis of the produced exudate. Vaginal swabs do not give an accurate picture of what is happening in the abdomen. For differential diagnosis of the disease, it is necessary to perform a puncture through the posterior fornix of the vagina or to do laparoscopy.

First aid

A person cannot independently determine an adhesive or exudative inflammatory process. For each type, an individual correction method is selected. Therefore, it is important to call an ambulance at the first manifestations of pathology.

While waiting for the ambulance, it is necessary to put the patient on a hard surface, and apply ice to the place of pain. It is impossible to give any painkillers or antispasmodics before the examination by doctors. Such drugs can provoke a decrease in the brightness of the clinical picture, as a result of which diagnosis will be difficult.

Treatment

Depending on the severity of the course, the cause and nature of the inflammation, an individual therapy regimen is selected for the patient. When treating with conservative methods, it is important to organize complete rest – sexual, physical, emotional. In most cases, therapy is performed in a hospital setting and requires hospitalization.

If pathogenic microflora is detected, treatment with broad-spectrum antibiotics is recommended. To accelerate the therapeutic effect, drugs are administered parenterally for 1-3 weeks. Before prescribing a treatment regimen, a bacteriological study is carried out, with the help of which it is possible to determine the sensitivity of microorganisms in relation to drugs.

During antibiotic treatment, detoxification therapy is prescribed in parallel, and plasma substitutes are administered. To provide symptomatic assistance in the treatment, painkillers, anti-inflammatory, antispasmodic drugs are used. Recommended vitamin therapy, sparing diet, drinking regimen.

The auxiliary methods are:

  • ultraviolet irradiation of blood;
  • ultrasonic impact on the abdominal organs;
  • electrophoresis;
  • phonophoresis.

In the rehabilitation period, massage and physiotherapy exercises are recommended to prevent the formation of adhesions in the small pelvis.

plastic

Plastic pelvioperitonitis is accompanied by adhesive process

Surgical intervention

Surgical treatment is resorted to in emergency cases, when there is a suspicion of exudate formation, internal bleeding, damage to the integrity of internal organs. Depending on the severity of the patient’s condition, the plastic surgeon performs an open operation or does a laparoscopy. The second method is preferred because it is less likely to lead to complications and is less traumatic.

During the operation, the inflammatory process is stopped, an antiseptic treatment of the abdominal cavity is performed, and, if necessary, bleeding wounds are sutured. In some cases, removal of pathological areas is required. If inflammation caused chronic endometriosis, accompanied by the formation, suppuration and rupture of the cyst, then often it is not possible to save the ovary.

Forecast

With the plastic form of the disease, when the formation of an adhesive process begins in the small pelvis, the prognosis is often unfavorable. As a result of the displacement of organs, their functionality is impaired. For this reason, women often remain infertile and have persistent pelvic pain. Timely detection, rapid diagnosis and a competent treatment regimen are the key to a favorable prognosis.

Conclusion

Pelvioperitonitis is a disease that cannot be ignored. Delay can not only adversely affect the state of health, but also lead to death. It is necessary to seek medical help at the first signs of inflammation of the abdominal wall. If the complex of symptoms is not caused by this pathology, the doctor will conduct an examination and give recommendations.

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See also: placentocentesis