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Pelvic abscesses

Abscesses of the pelvic cavity are a delimited accumulation of pus in the cystic-uterine or rectal-uterine space. Such abscesses can form with purulent-inflammatory saccular masses in the appendages, as well as in the postoperative period. In this case, the resulting adhesions delimit the accumulation of pus from the free parts of the abdominal cavity. Initially, an inflammatory infiltrate is formed, which may include loops of the intestines, omentum, walls of the bladder, uterus and rectum. With the subsidence of the inflammatory reaction, a pyogenic capsule is formed. With an abscess, intoxication and the risk of opening the capsule in the abdominal cavity, rectum or vagina always take place. Abscesses form on the 5-8th day after surgery and later.

The clinical picture is characterized by an increase in temperature (permanent or hectic type) from 4-6 days of the postoperative period, pains in the lower abdomen, increasing changes in the blood (increased ESR, leukocytosis, etc.). When an abscess is opened and pus enters the abdominal cavity, symptoms of peritoneal irritation and other symptoms of peritonitis occur.

For the purpose of diagnosis, abdominal puncture through the posterior arch, ultrasound, computed tomography, laparoscopy are used.

Surgical treatment. Previously, preference was given to opening abscesses through the posterior arch, but now operations are performed transabdominally. Abdominal drainage is carried out through additional incisions in the iliac regions and through the posterior vaginal fornix.

Postoperative abscesses of the pelvis, abdominal cavity and retroperitoneal spaces in gynecological practice are currently rare. Most often, abscesses of the pelvic cavity are observed. They occur in women mainly after operations for purulent-inflammatory processes, less often - for other reasons.

The main condition for the development of postoperative abscesses is a decrease in nonspecific resistance of the body and immune mechanisms.
More often they arise when it is impossible to radically remove foci of the inflammatory process.

Interloop abscesses are a limited accumulation of pus between the loops of the small and large intestines. In gynecological practice are rare. They develop during gynecological operations for diseases accompanied by general or diffuse peritonitis.

The emergence of interloop abscesses contributes to inadequate sanitation of the abdominal cavity, inadequate drainage. More often they are observed in the ileocecal region, in the right or left side channels.

Clinically, the disease is initially manifested by paresis of the intestine at subfebrile temperature. Subsequently, the symptoms become more pronounced: severe abdominal pains appear, high (38-39 ° C) temperature, typical for the inflammatory process of changes in blood counts. Perhaps the development of intestinal obstruction, both paralytic (due to irritation of the nerve endings of the intestine), and mechanical (due to compression of the intestine with infiltration, the formation of bends). With several interlobular abscesses, the clinic resembles diffuse peritonitis. Radiological, ultrasound, and computed tomography help identify interloop abscesses.

Treatment at the stage of infiltrates can be conservative (cold, detoxification, antibacterial therapy), with the formation of abscesses - surgical. Dissection of abscesses, emptying from pus and drainage are performed transabdominally or through incisions made extraperitoneally directly above the abscess area.

Less commonly, in gynecological practice, there are postoperative subphrenic abscesses (in the upper floor of the abdominal cavity limited by the diaphragm above), retroperitoneal abscesses, liver abscesses, spleen and other localizations.
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Pelvic abscesses

  1. OPENING AND DRAINING OF THE ABCESSES OF THE SMALL PELVIS THROUGH THE VAGINA
    Pelvic abscesses can open through the vagina if there are three conditions: 1) the abscess must be fluctuating; 2) the abscess should exfoliate rectovaginal septum; 3) the abscess should be located in the midline. If any of the conditions is absent, then the risk of possible complications increases significantly. If the abscess does not fluctuate, it cannot be completely drained. If the abscess is not
  2. Pelvis Organs
    Research Technique. Pelvic organs are examined after removing them in one complex. After thoroughly examining the organs in situ, the first and second fingers of the left hand are inserted, the palmar surface facing the pelvic organs, behind the peritoneum between the bladder and the pubic joint, and the tissues connecting them are torn with fingers. Moving deeper, bluntly separate the pelvic organs in front of
  3. Surgical approaches to the pelvic organs
    Most surgical interventions in gynecological practice are performed with access to the pelvic organs. It is realized by transabdominal and transvaginal gluttony. Less commonly used in gynecological surgery are extraperitoneal
  4. INFLAMMATORY DISEASES OF THE PELVIC ORGANS
    The term "pelvic inflammatory disease" (PID) combines the entire spectrum of inflammatory processes in the upper reproductive tract in women. These are endometritis, salpingitis, tubo-ovarian abscess and pelvioperitonitis as separate nosological forms and in any possible combination. The main pathogens Proved polymicrobial etiology of VZOMT, with a predominance
  5. Anatomy of the anterior abdominal wall and surgical approaches to the pelvic organs
    Operations on the pelvic organs are carried out mainly using two approaches: transabdominal and transvaginal. In this regard, the anatomy of the abdominal wall and pelvic organs is described. {foto83} Fig. 41 (beginning). Topography of muscles, vessels and nerves of the anterior abdominal wall. Vertical section: 1 - round ligament and fatty tissue of the inguinal canal; 2 - ramus cutaneus n.
  6. REMOVING THE BODIES LOCATED IN THE BACK OF THE SMALL PELVIS (BACK EXENERATION)
    Currently, this operation is rarely performed to treat cervical carcinoma and the upper vagina. Its volume is often insufficient, the bladder is deprived of innervation, and very often fistulas occur. More often than not, we prefer to perform full exenteration. In the presence of indications and opportunities, reconstructive operations with the formation of a permanent colostomy were performed earlier.
  7. Symptoms of pelvic inflammatory disease
    Some diseases of the female genital organs can proceed unnoticed, but in most cases, women complain of the following symptoms: • pain in the lower abdomen; • unusual vaginal discharge; • fever and general malaise; • discomfort during urination; • irregular menstruation; • pain during sexual intercourse. How is a diagnosis established?
  8. Examination of the organs of the abdomen and pelvis
    It should be taken as a rule: opening the stomach, do not touch anything until the entire abdominal cavity has been examined. If you do not follow this rule, you can violate the position of the authorities and miss something very important. Therefore, first carefully examine the organs without touching them, and make an impression of their situation. A system is also needed here: it is better to start the examination from the upper abdomen and go to
  9. REMOVAL OF BODIES LOCATED IN THE FRONT OF THE SMALL PELVIS (FRONT EXENERATION)
    This operation is performed with the ineffectiveness of radiation therapy for cancer of the anterior pelvic organs. The operation can be successful in some cases with carcinoma of the urethra and bladder, when the vagina and cervix are involved in the pathological process. The purpose of the operation is the removal of the bladder, urethra, vagina, uterus, as well as all adjacent tissues, up to the small wall
  10. Pelvic and pelvic injuries
    Scope of examination 1. Distinguish between isolated fractures (pubic, sciatic, iliac) and multiple fractures of the pelvic bones. 2. Multiple fractures are accompanied by massive blood loss into the retroperitoneal space and pelvic tissue with shock phenomena of varying severity. 3. In pelvic fractures, the most common complications are ruptures of the bladder and
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