According to the clinical course of the disease, two clinical forms of suppurative inflammatory diseases of internal genital organs are distinguished on the basis of pathomorphological studies: uncomplicated and complicated. Uncomplicated forms include only acute purulent salpingitis, to complicated - all of the tumescent inflammatory tubo-thoracic formations.
Diagnosis of acute purulent salpingitis should be based on the following three mandatory criteria: the presence of abdominal pain, sensitivity to cervical dislocation, and sensitivity in the appendages in combination with at least one of the additional criteria (temperature above 38 ° C, leukocytosis, Increased ESR). Ultrasound is not a highly informative method for diagnosing acute purulent salpingitis, but it should be used before invasive methods of investigation.
Laparoscopy is not only the most informative method for diagnosing uncomplicated forms of purulent inflammation, but also one of the main surgical components of the conservative surgical tactics of conducting similar reproductive-age patients. Selection of adequate antibiotic therapy, laparoscopic sanation and drainage of the pelvic cavity allows to achieve the desired effect.
Clinical sign of complication development is an increase in the symptoms of purulent intoxication (the appearance of hectic fever, nausea, vomiting, a constant feeling of dryness in the mouth, a sharp muscle weakness). The tubo-ovarian abscess is a pus-filled stretched fallopian tube (pyosalpinx) and a molten ovary, to which the intestinal loops are often soldered. This is the final stage of acute inflammatory disease of the pelvic organs. A tubo-ovarian abscess should be suspected if a patient under a bimanual examination determines volume formation.
Purulent formation in the small pelvis is characterized by fuzzy contours, uneven consistency, complete immobility and pronounced soreness. Echographic signs of purulent tubo-ovarian formations:
- 1. In the cavity of the small pelvis a pronounced adhesive process is determined. Pathological formations are fixed to the rib and the posterior wall of the uterus. In most patients, a single conglomerate without distinct contours is defined, consisting of the uterus, pathological formation, the bowel loops and the omentum.
- 2. The form of inflammatory formations is often irregular, but still approaches ovoid.
- 3. The size of the formation is from 5 to 18 cm, the area is from 20 to 270 cm2.
- 4. Internal structure of purulent inflammatory formations differs polymorphism. It is heterogeneous and is represented by a medium-dispersion suspension against the background of an increased level of sound transmission.
- 5. Contours of purulent formations can be represented by the following options:
- Echopositive thick capsule (up to 1 cm) with clear contours;
- Echopositive capsule with areas of uneven thickness;
- education without clear contours (the capsule is not clearly traced all over).
Significantly facilitates the diagnosis of pelvic abscesses and lesions of the distal intestine, a method of additional contrasting of the rectum. The diagnostic capabilities of computed tomography and magnetic resonance imaging are the highest among all non-invasive methods of investigation.
If early complete and adequate treatment of purulent salpingitis is possible full recovery of patients and recovery of reproductive function, then with purulent tubo-ovarian formations the prospects for subsequent childbearing are sharply reduced, and recovery comes only after surgical treatment.
With untimely surgical treatment and further progression of the purulent process, complications such as perforation of the abscess into the genital organs and anterior abdominal wall with the formation of simple and complex genital fistulas or microperforation of the abscess into the abdominal cavity with the formation of intercuspal and subdiaphragmatic abscesses appear.
Purulent-infiltrative lesions of the small pelvic tissue - parametrite, pancellulitis.
The development and progression of the parametrite is characterized by several stages. The process begins with hyperemia, expansion of blood and lymphatic vessels, serous tissue impregnation, the appearance and progression of edema. Gradually the exudate is replaced by an extremely dense infiltrate (the stage of compaction of the exudate). This is due to the deposition of fibrin. The most common form of parametrism in patients with purulent formations of the uterine appendages is posterior and lateral, although in some cases other parts of the parameter are involved in the process. As a rule, the course of the parametrix in these patients is limited to the stage of infiltration.
However, in some rare cases (3.1%), purulent melting of parametric fiber may occur. Such abscessing always sharply burdens the course of the underlying disease:
- 1. The affected parameter is sharply painful and infiltrated, and the infiltrate reaches the pelvic bones and spreads towards the anterior abdominal wall.
- 2. The lateral vault of the vagina is sharply shortened.
- 3. The cervix is asymmetrically relative to the midline and is shifted in the direction opposite to the defeat of the parameter and the cessation.
- 4. Displacement of the pelvic organs (conglomerate) is almost impossible because of the vastness of the infiltrate and the spread of the process into the parameter. One of the options for opening such an abscess is emptying it into the bladder.
- 5. During rectal-vaginal examination there is a prolapse of the infiltrate or abscess in the direction of the rectum; The condition of the mucosa above it (mobile, limited mobile, immobile) reflects the fact and extent of involvement in the inflammatory process of the anterior wall or lateral walls of the rectum.
Only urgent surgery can save a patient in this situation. In this regard, with the development of a purulent parametritis, as a complication of purulent inflammatory diseases of the uterine appendages, an urgent operation is required. The scope of intervention and the principles of patient management are individual.