Obstetrics and gynecology. Pelvioperitonitis and parametritis (most important)

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Obstetrics and gynecology. Pelvioperitonitis and parametritis (most important)

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49. Pelvioperitonitis and parametritis

Pelvioperitonitis is an inflammation of the peritoneum, limited to the pelvic cavity. It develops as a result of the spread of the inflammatory process in the pelvic organs (salpingoophoritis, pyovaritis, torsion of the leg of the ovarian tumor, necrosis of the myomatous node, perforation of the uterus). Along the course, acute and chronic pelvioperitonitis are distinguished. In acute pelvioperitonitis, the process is localized in the small pelvis, however, the peritoneum of the upper abdominal cavity also reacts to the inflammatory process. The patient notes sharp pains in the lower abdomen, body temperature rises, dyspeptic symptoms occur: nausea, vomiting, bloating, stool and gas retention, painful urination. There are pronounced signs of intoxication. Dullness of percussion sound is determined in the sloping places of the lower abdomen, associated with the presence of effusion in the abdominal cavity. Intestinal peristalsis is sluggish, gases go badly. Vaginal examination determines the overhang of the posterior fornix, pain on palpation and displacement of the cervix. The uterus with appendages is palpated with difficulty due to severe pain and tension of the anterior abdominal wall. In the blood, neutrophilic leukocytosis with a shift to the left, toxic granularity of neutrophils, increased ESR are detected.

Treatment. Antibacterial, infusion, detoxification, desensitizing and restorative therapy is carried out. If the causes of pelvioperitonitis are rupture of the pyosalpinx, perforation of the uterus, necrosis of a tumor of the uterus or ovary, then urgent surgical intervention is indicated.

Parametritis is an inflammation of the peritoneal tissue. The reason for the development of parametritis is most often previous intrauterine interventions: childbirth, abortion, supravaginal amputation of the uterus, removal of appendages, diathermocoagulation. Postpartum parametritis most often occurs with ruptures of the cervix and the upper third of the vagina. Infection with parametritis spreads through the lymphogenous route. Diagnosis of parametritis is based on bimanual examination data. The mucous membrane of the vagina during palpation and examination of the vaults is motionless due to infiltration. Due to the existing anatomical features of the parametric fiber (on the one hand it is limited by the uterus, on the other hand by the pelvic wall, from below by the vault of the vagina), the cervix, the uterus itself and the vaginal vault are immobile with parametritis.

With unilateral parametritis, the cervix is deviated in the opposite direction from the pathological process. The infiltration has a dense, painful, motionless texture, fanning out from the side wall of the uterus to the walls of the pelvis along the anterior or posterior surface. In a severe infection, inflammation can move to neighboring sections of the pelvic tissue. Therapy of parametritis is carried out according to the general rules for the treatment of inflammatory diseases, taking into account the specifics of the process. Includes antibacterial, desensitizing and restorative therapy. In case of suppuration of the infiltrate, drainage is performed.

Author: Ivanov A.I.

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