Symptoms and approaches to treatment of different types of pelvioperitonitis

Pelvioperitonitis is an inflammation of part of the pelvic peritoneum. Considered as a primary and secondary disease. The development of primary pelvioperitonitis is preceded by the penetration of infection through the lymphatic or blood vessels into the pelvic cavity (tonsillitis, boil, pneumonia, etc.). Foci of infection can be:

• the fallopian tubes;
• uterus, ovaries;
• suppuration of the uterine hematoma;
• appendicular processes or other abdominal organs;
• suppuration of a cyst or cystadenoma (torsion of its legs).

The cause of secondary pelvioperitonitis is a complication of another disease. In other words, initially favorable conditions were created for the infection to penetrate from the female genital tract into the pelvic region.

This can be facilitated by inflammatory processes in the fallopian tubes, a puncture of the uterus made during an abortion, gynecological operations (artificial birth, contrast examination of the fallopian tubes and uterus), colpitis, oophoritis, etc.

With purulent lesions of the appendages, pelvioperitonitis and subsequent complications are very severe, since the body already has chronic purulent processes.

In this case, pelvioperitonitis has a recurrent nature: after inflammation subsides, adhesions and adhesions remain between the adnexal formation and the pelvic peritoneum (chronic adhesive pelvioperitonitis), and in the event of the next exacerbation, the disease spreads further along the pelvic peritoneum.

Acute pelvioperitonitis is characterized by progression of the process in the case of specific inflammation or a sharp activation of infection against the background of a chronic purulent focus already present in the uterine appendages, which arose as a result of a breakdown in compensatory immune reactions.

Acute pelvioperitonitis, in essence, can be considered one of the forms of peritonitis (limited, or local peritonitis).

The possibilities for the development of complications depend on the immune system, the aggressiveness of the flora, and the prevalence of inflammatory processes.

The development of pelvioperitonitis as a result of ascending gonorrhea should not be underestimated, since with inadequate treatment the disease can cause complications in the form of the formation of pelvic abscesses and the development of peritonitis.

Pelvioperitonitis is divided depending on the prevalence into:

• diffuse (involves both parietal and visceral peritoneum);
• partial (located near the source of infection, clearly limited);
• adhesive (proceeds with the formation of adhesions);
• exudative (effusion) pelvioperitonitis is distinguished by the predominant changes that have occurred in the pelvis.

The manifestation and development of pelvioperitonitis depend mainly on the state of immunity and the causative agent of infection.

The disease begins abruptly. Body temperature rises to 38-390C, pulse and breathing become more frequent. The woman is worried about malaise, sweating, weakness, chills, severe nagging pain in the lower abdomen, bloating as a result of tension in the muscles of the anterior abdominal wall, nausea, dry mouth, hiccups and vomiting.

After the inflammatory focus is limited to adhesions formed in the pelvis (this happens within 1-2 days), the woman’s well-being worsens, turning into a more serious condition.

There is constant pain and bloating in the lower abdomen, and body temperature increases. The upper limit of the resulting inflammatory conglomerate can be determined by the tension of the muscles of the anterior abdominal wall.

A sharp pain is felt in the posterior vaginal fornix during examination.

In a situation of purulent pelvioperitonitis, the woman’s condition is very serious. Pus, which has accumulated in large quantities in the pelvis, expands into the abdominal cavity, which becomes the beginning of general peritonitis.

The functions of many vital organs are impaired. Abdominal pain is diffuse. The mouth feels dry, often nausea and vomiting.

The muscles of the anterior abdominal wall are tense, this is accompanied by retention of gases and stool.

In situations where adhesive processes predominate during pelvioperitonitis, symptoms develop more slowly. And yet, the formation of numerous adhesions in the internal organs leads to dysfunction of the intestines, genitals, bladder, and decreased ability to work.

The diagnosis of pelvioperitonitis is made on the basis of:

• life history: the gynecologist collects it during communication with the client;
• laboratory tests: peripheral blood is analyzed to identify significantly pronounced leukocytosis, increased ESR, toxic anemia, a positive reaction to CRP;
• physical examination: to confirm positive symptoms of peritoneal irritation, pain on palpation of the abdomen, palpation of the infiltrate;
• gynecological examination;
• instrumental studies: pelvic ultrasound (determine the presence of free fluid in the pouch of Douglas), puncture of the posterior vaginal vault, bacteriological examination of the punctate, laparoscopy, radiography of the abdominal organs;
• consultations with other specialists.

Prevention of pelviperitonitis comes down to measures that prevent inflammatory diseases in the genital organs, and these are:

• prevent and promptly treat complications arising in connection with abortion, childbirth and those developing in the postoperative period;
• use of barrier contraception (COC);
• treatment of sexual partners;
• be informed about risk factors for sexually transmitted infections.

Treatment of this disease is complex and necessarily comprehensive. It is carried out taking into account the characteristics of the infectious agent, the stage of the process, the clinical picture of the disease, the degree of dysfunction of vital organs and metabolic processes.

Treatment of pelvioperitonitis can be divided into general and local.

Goals of general therapy:

• reduce body intoxication;
• infection control;
• restore impaired functions of internal organs;
• normalize the water-electrolyte, acid-base state of the body and protein metabolism;

Local therapy for pelvioperitonitis includes:

• removal of the organ that is the source of infection, and at the earliest possible time;
• combating intestinal obstructions and restoring intestinal functions.

So, the treatment process for pelvioperitonitis usually includes:

• complete peace;
• periodically applying an ice pack to the lower abdomen;
• a complete gentle diet;
• mineral therapy and vitamin therapy;
• therapy with broad-spectrum antibiotics, taking into account the sensitivity of the infectious agent;
• use of antihistamines;
• improving the functioning of the cardiovascular, nervous and other systems;
• infusion therapy (drip administration of drugs) to restore water-electrolyte and cyst-alkaline balance;
• use of antibacterial drugs from other groups;
• the use of drugs to improve intestinal motility;
• possible ultraviolet irradiation of blood.

In the surgical treatment of pelvioperitonitis, the organ that is the source of infection is eliminated. The inflammatory discharge is removed and the outflow of exudate is ensured, that is, the pelvic cavity is drained. In the postoperative period, the main tasks are to maintain and restore normal homeostasis against the background of therapy started before surgery.

After inpatient therapy, follow-up treatment is usually carried out in the antenatal clinic. Its goal is to completely restore the impaired functions of internal organs. Mostly non-medicinal means are used to influence the female body, for example: balneotherapy, physiotherapy, climate therapy, massage, hydrotherapy, etc.

The main condition for successful treatment of this disease is timely consultation with a doctor.

Source: https://nebolet.com/bolezni/pelvioperitonit.html

Pelvioperitonitis

Pelvioperitonitis is a local infectious and inflammatory lesion of the serous covering (peritoneum) of the small pelvis. The development of pelvioperitonitis is manifested by high fever with chills, intoxication, severe abdominal pain, bloating and tension in the muscles of the abdominal wall. Diagnosis of pelvioperitonitis includes a gynecological examination, ultrasound, laparoscopy, and background examinations. Therapy of pelvioperitonitis requires the appointment of massive antimicrobial, infusion therapy, UVOC, immunocorrection, and therapeutic punctures. For purulent pelvioperitonitis, colpotomy, laparoscopy and drainage of the pelvic cavity are indicated.

Pelvioperitonitis is characterized by a local inflammatory reaction in the pelvis: microcirculation disorders, increased vascular permeability, the release of fibrinogen, albumin, leukocytes beyond the vascular bed, and the formation of serous or purulent effusion.

In the affected area, histamine, serotonin, organic acids accumulate, and the concentration of hydroxyl and hydrogen ions increases. The peritoneal endothelium undergoes dystrophic changes.

Due to acute inflammation, adhesions form between the peritoneum, pelvic organs, intestinal loops, omentum, and bladder.

The course of pelvioperitonitis can be accompanied by the accumulation of exudate in the utero-rectal space with the formation of a Douglas abscess, the breakthrough of which into the free abdominal cavity leads to the development of diffuse peritonitis.

Pelvioperitonitis is caused by Escherichia coli, staphylococcus, gonococcus, chlamydia, mycoplasma, viruses, anaerobes, and more often microbial associations - in the latter case its course becomes more severe.

Classification of pelvioperitonitis

Clinical gynecology distinguishes between secondary pelvioperitonitis, caused by inflammatory diseases, and primary pelvioperitonitis, which develops when infection directly penetrates the pelvic cavity.

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• Taking into account the local prevalence, partial pelvioperitonitis is distinguished with a limited area of ​​inflammation near the source of infection and diffuse, involving the parietal and visceral peritoneum of the small pelvis.
• Based on the type of predominant changes in the pelvis, pelvioperitonitis is divided into adhesive (adhesive, occurring with the formation of adhesions) and exudative (effusion).

According to the nature of the inflammatory exudate, pelvioperitonitis can be serous-fibrous, hemorrhagic or purulent.

The nature of the exudate in pelvioperitonitis depends on the type of pathogen or their associations. Staphylococcal pelvioperitonitis is accompanied by serous-purulent or purulent effusion; with rod flora, the exudate is serous-purulent with a foul fecal odor.

With viral and chlamydial pelvioperitonitis, the inflammatory discharge is often serous or serous-purulent; with gonorrheal etiology - purulent-hemorrhagic.

Causes of pelvioperitonitis

More often, the development of pelvioperitonitis is preceded by some kind of infectious and inflammatory process in the pelvis.

In this case, pelvioperitonitis is secondary and serves as a complication of acute adnexitis, serous or purulent salpingitis, purulent tubovarial formations (piovara, pyosalpinx), suppurating uterine hematoma, genital tuberculosis, gonorrhea, metroendometritis, appendicitis, sigmoiditis, intestinal obstruction, etc.

Pelvioperitonitis often manifests against the background of decreased general resistance, stress, menstruation, and hypothermia.

Symptoms of pelvioperitonitis

The development of pelvioperitonitis is acute: the disease begins with a sharp increase in temperature to 39-40 ° C, the appearance of intense pain in the lower abdomen, periodic chills, tachycardia (up to 100 or more beats per minute), nausea, gas retention, painful urination, bloating.

Objectively, pelvioperitonitis reveals symptoms of intoxication, weakened peristalsis, and a dry tongue coated with a grayish coating. Positive signs of peritoneal irritation are more pronounced in the lower abdomen and weaker in its upper half.

A somewhat more blurred picture characterizes the course of chlamydial pelvioperitonitis. In this case, symptoms increase gradually, but there is a tendency for early formation of adhesions.

During diagnosis, pelvioperitonitis is differentiated from peritonitis, parametritis, pyosalpinx, appendicitis, ectopic pregnancy, and torsion of the pedicle of an ovarian tumor.

Patients with suspected pelvioperitonitis require urgent hospitalization in a gynecological hospital.

Diagnosis of pelvioperitonitis

The presence of pelvioperitonitis can be assumed by a gynecologist based on the patient’s medical history. An analysis of peripheral blood in pelvioperitonitis reveals an increased ESR, significant leukocytosis with a shift to the left, and toxic anemia. A blood test for CRP gives a sharply positive reaction.

Palpation of the abdomen reveals tension in the abdominal muscles, the upper limit of the inflammatory infiltrate in the pelvis, and positive peritoneal symptoms. Bimanual vaginal examination is accompanied by severe pain in the area of ​​the uterus and appendages; due to effusion, there is protrusion of the posterior vaginal vault, displacement of the uterus anteriorly and upward.

In order to identify microbial agents, a bacteriological examination of the vaginal discharge and cervical canal and ELISA diagnostics are carried out. However, since the vaginal microflora may not reflect the processes developing in the pelvis, in case of pelvioperitonitis, diagnostic laparoscopy or puncture through the posterior vaginal fornix to collect exudate is justified.

Treatment of pelvioperitonitis

At the prehospital stage, until the diagnosis of pelvioperitonitis is established, the administration of painkillers is contraindicated; As a measure to alleviate the condition, only applying ice to the lower abdomen is allowed.

Therapy for pelvioperitonitis is complex, aimed at suppressing the infectious process, relieving pain symptoms and intoxication. Surgery is performed according to indications.

In the acute period of pelvioperitonitis, bed rest, rest, position in bed with the head of the bed raised, and cold on the stomach are recommended.

Taking into account the identified microbial flora, antibiotics from the groups of semisynthetic penicillins (amoxicillin, oxacillin), cephalosporins (cefazolin, cefotaxin, cephalatin), fluoroquinolones (ciprofloxacin), macrolides, aminoglycosides, tetracyclines, imidazoles (metronidazole, metrogil), etc. are indicated. Detoxification infusion is carried out therapy , administration of plasma and plasma substitutes, protein hydrolysates.

Courses of drug therapy for pelvioperitonitis include antihistamines, painkillers and anti-inflammatory drugs, and vitamins. To restore the vaginal biocenosis, lactobacterin and bifidumbacterin are prescribed.

A good effect for pelvioperitonitis is achieved by ultraviolet blood irradiation (UFOI). After the acute phenomena of pelvioperitonitis subside, physiotherapy is carried out: ultrasound, electrophoresis, phonophoresis, microwave, UHF, laser therapy, exercise therapy, massage.

Patients with pelvioperitonitis are shown therapeutic punctures through the posterior vaginal fornix with evacuation of effusion, administration of antibiotics and antiseptics. If purulent exudate is detected, posterior colpotomy or laparoscopy with drainage of the pelvic cavity and intra-abdominal infusions is indicated for its evacuation.

If uterine perforation, necrosis of tumor nodes, pyosalpinx, pyovar, or tubo-ovarian abscess is suspected, emergency transection is performed. The scope of surgical treatment in this case is determined by the clinical situation. In case of complicated pelvioperitonitis, adnexectomy, supravaginal amputation of the uterus with appendages, or panhysterectomy can be performed.

Forecast and prevention of pelvioperitonitis

With proper and timely treatment of pelvioperitonitis, the disease ends in complete recovery. The best long-term results in the treatment of pelvioperitonitis are achieved with active tactics - punctures, laparoscopy, drainage. In this case, the percentage of subsequent pregnancies is higher than with conservative management.

After suffering pelvioperitonitis, the patient may suffer from infertility, miscarriage, development of ectopic pregnancy, recurrent inflammation, and pelvic pain syndrome.

To exclude factors leading to the development of pelvioperitonitis, it is necessary to have a preventive examination by a gynecologist, timely treatment of genital infections, the use of barrier methods of contraception, timely removal of the IUD, preventive antimicrobial therapy after gynecological operations, and prevention of complications associated with abortion, childbirth, and intrauterine manipulation.

Source: https://zdravnica.net/catalog/illness-and-disease/160-p-disease/1871-pelvioperitonit

Pelvioperitonitis in gynecology - causes, symptoms and treatment, adhesive, plastic and other forms of the disease

Pelvioperitonitis is an infectious-inflammatory process that develops in the pelvic peritoneum only in women.

In the absence of adequate treatment, the cells at the site of inflammation undergo dystrophic changes, resulting in the formation of adhesions between the intestinal loops, pelvic organs, bladder and peritoneum.

The main cause of pelvioperitonitis is pathogens such as staphylococci, gonococci, chlamydia, and E. coli. They can enter the abdominal cavity during:

• performing gynecological procedures - installing a spiral, blowing out the fallopian tubes, curettage, termination of pregnancy (especially if aseptic and antiseptic rules are not followed);
• surgery resulting in infection of the uterus;
• inflammatory process that occurs in the uterus, ovaries, fallopian tubes, vagina;
• complicated appendicitis;
• intestinal obstruction;
• rupture of a fibroid node or torsion of a leg.

Provoking factors are:

• early onset of sexual activity;
• lack of a permanent sexual partner;
• incorrect use of the spiral;
• hypothermia;
• stress.

An important provoking factor is decreased immunity. Normally, the body eliminates pathogens on its own. But when the immune system fails, an inflammatory process often occurs.

Symptoms and types of disease

According to the degree of severity, pelvioperitonitis is divided into acute and chronic. Acute inflammation begins suddenly. The main symptoms are:

• strong pain;
• feeling of heaviness in the pelvic organs;
• temperature increase;
• chills;
• dizziness;
• vomit;
• general weakness;
• in some cases, painful shock occurs.

These signs are indications for hospitalization and surgery.

Chronic pelvioperitonitis is a sluggish process in which acute attacks periodically occur. The chronic stage is characterized by the following symptoms:

• slight pain;
• the temperature is normal, sometimes there is a slight increase to 37.5°C;
• frequent urination;
• bloating;
• during intimacy, a woman experiences pain and discomfort;
• the menstrual cycle is disrupted;
• vaginal discharge increases.

Exacerbations occur against the background of decreased immunity.

Other criteria for the classification of pelvioperitonitis: table

Depending on the pathogen, the effusion will also vary.

Types of exudate in disease: table

Diagnostics

Diagnosis of pelvioperitonitis begins with data collection. The specialist finds out whether there were inflammatory diseases of the pelvic organs and provoking factors.

A physical examination is then performed. Upon palpation, the woman feels a sharp pain in the lower abdomen. The specialist prescribes a series of laboratory and instrumental studies to exclude other pathologies (ectopic pregnancy, ovarian apoplexy, parametritis, etc.).

Main types of research: table

Treatment

The main goals of treatment are:

• stopping acute inflammation;
• stabilization of the patient's condition;
• preventing the development of complications.

There are medical and surgical treatments.

Conservative treatment methods are allowed for uncomplicated forms, as well as during preparation for and after surgery.

Types of drugs used in therapy: table

Surgical intervention

The indication for surgical intervention is the development of a purulent process. The main goal of the operation is to completely remove the source of infection. There are several types of surgical intervention, which differ in complexity, complications and recovery time for the patient. These include:

1. Abdominal puncture. It is performed through the back wall of the vagina. During puncture, exudate is taken for bacteriological examination. Then a mixture of antibacterial and antiseptic agents and a 5% novocaine solution is introduced. If the exudate is serous, then 2-3 procedures will be required, if purulent - 4-10.
2. Laparoscopy. This operation is considered gentle because it is performed through a small incision. The likelihood of complications is minimal, recovery occurs quickly.
3. Laparotomy . This is an abdominal operation in which abscesses are opened and drained. High risk of complications and reproductive dysfunction.

Traditional recipes should be used in conjunction with taking medications or during the rehabilitation period.

Herbal medicine to maintain patient health: table

The patient must adhere to a gentle diet, especially for the postoperative period. It is recommended to exclude spicy, pickled and smoked foods. It is advisable to steam, bake or boil dishes.

Prognosis and complications

The prognosis for life is favorable. For reproductive function, the prognosis will depend on the timeliness of treatment started. If the disease remains for a long time without adequate treatment, then the risk of complications is quite high. This:

• diffuse peritonitis (inflammation spreads to the entire abdominal cavity);
• sepsis (germs and pus enter the general bloodstream);
• development of adhesions in the pelvic area;
• infertility or miscarriage;
• ectopic pregnancy;
• death.

Prevention

To prevent the entry of various pathogenic pathogens into the abdominal cavity and internal genital organs, it is recommended:

• promptly treat infectious and inflammatory diseases of the female genital organs;
• observe the rules of intimate hygiene;
• avoid casual sex without using condoms;
• undergo regular preventive examinations with a gynecologist.

Pelvioperitonitis is a disease with severe symptoms and consequences. When you notice the first symptoms, you should consult a gynecologist and not self-medicate. Timely complex therapy will ensure a quick recovery without complications.

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Source: https://medknsltant.com/pelvioperitonit/

Pelvioperitonitis in gynecology - causes, diagnosis, treatment and symptoms

Pelvioperitonitis is a dangerous disease that affects exclusively women, and of different age categories. Girls, women of mature childbearing age and older people are affected. As with any inflammation, pelvioperitonitis is characterized by a triad of symptoms:

• pain concentrated in the lower abdomen;
• hyperthermia or heat in the pelvic peritoneum and the patient’s body;
• a circulatory disorder accompanied by increased vascular permeability and the formation of effusion.

Complications are dangerous: the development of diffuse peritonitis with multiple abscesses, the formation of adhesions and adhesions characteristic of adhesive pelvioperitonitis, and impaired reproductive function. Late access to doctors and untimely treatment can cause the death of patients.

Pelvioperitonitis is a disease that occurs against the background of infectious processes in the lower part of the peritoneum. Can affect any pelvic organs. It is noteworthy that the disease can develop in both older women and little girls. Without comprehensive treatment, it can cause dangerous complications.

Classification

In gynecology, a distinction is made between primary pelvioperitonitis, which occurs when infection directly enters the pelvic cavity, and secondary, caused by inflammatory diseases.

Also, taking into account the local prevalence, a diffuse form of pathology is distinguished, involving the visceral and parietal peritoneum of the small pelvis, and a partial form - with a limited area of ​​​​inflammation around the source of infection.

Based on the type of predominant changes in the pelvic organs, the disease is divided into exudative (effusion) and plastic, or adhesive (proceeding with the formation of adhesions). According to the nature of the exudate (liquid released into the body cavity or tissue from small blood vessels), pelvioperitonitis can be purulent, hemorrhagic or serous-fibrous.

This depends on the type of pathogen or their associations. With rod flora, it is serous-purulent with a fetid odor. Staphylococcal pelvioperitonitis is accompanied by purulent or serous-purulent effusion. With chlamydial and viral pelvioperitonitis, the discharge is often serous. The gonorrheal form is characterized by purulent-hemorrhagic exudate.

This disease is usually classified according to several parameters.

The following types are distinguished:

• Primary. In this case, the infection penetrates directly into the pelvic area. This happens during gynecological manipulations or injuries to the lower abdomen.
• Secondary. Occurs as a result of other inflammatory processes in the body.

According to the prevalence of pelvioperitonitis in gynecology, it is customary to distinguish:

• Partial (limited). The inflammatory process covers a limited area near the source of the pathological process.
• Diffuse. The most dangerous type, in which inflammation affects the entire pelvic area. Often a complication of the partial type.

According to the clinical picture, the disease is divided into the following types:

• Spicy. Most common. Symptoms that appear suddenly are very pronounced.
• Chronic. The course is sluggish, the symptoms are poorly expressed. If the immune system is disrupted, it can worsen. This type of disease is often caused by untreated acute pelvioperitonitis. It requires careful therapy, as it can cause dangerous consequences, because in the chronic course of the disease, the inflammatory process is constantly present in the body.

Many experts distinguish several stages of the development of the disease:

• Initial. Infectious agents first enter the tissue, infecting cells and causing swelling.
• Serous. The affected cells begin to secrete serous fluid. With a progressive inflammatory process, serous effusion is released in large quantities. Characteristic of viral inflammation.
• Purulent. Dangerous stage of disease development. It occurs as a result of primary damage to the body by bacteria or the addition of bacterial flora to an existing fungal or viral process. This stage can cause serious complications, especially in the absence of timely treatment.

It is also worth noting the types of inflammatory process. These include:

• Exudative. With this type of inflammation, a large amount of effusion is formed in the pelvic area.
• Adhesive pelvioperitonitis in gynecology, what is it? This type of disease is the most severe, in which a sticky, glue-like exudate very quickly forms. It is dangerous because it glues the pelvic organs together, forming a large number of adhesions. They, in turn, can provoke pain in the pelvic area, tubal obstruction and infertility. This type is also called plastic pelvioperitonitis in gynecology.

Causes of the disease

The causes of pelvioperitonitis are multiple. The main part of inflammation of the pelvic peritoneum is caused by pyogenic microbes. The disease, as a rule, develops with mechanical damage to the pelvic organs after open injuries, perforation of the uterus, during childbirth, or abortion. Sometimes acute pelvioperitonitis develops against the background of:

• metritis;
• parametritis;
• endomyometritis;
• disintegration of the fibroids node;
• tuberculosis;
• appendicitis;
• salpingoophoritis;
• diagnostic curettage;
• torsion of the stalk of fibroids or ovarian tumors and a number of other diseases.

The cause of the disease in young and young women is early sexual activity, multiple changes of sexual partners, and uncontrolled use of intrauterine contraceptives. Complications in women arise from self-treatment, late seeking medical help, incorrect initial diagnosis, and inadequate treatment of chronic diseases.

Conservative therapy

Conservative treatment involves the use of medications and is used in cases where the disease has not yet reached a critical stage. The drugs used in this case include:

• Antibiotics, which are the basis of all treatment. For example, Amoxicillin, Ceftriaxone, Dipril. But for better treatment effectiveness, it is recommended to carry out bacterial culture for sensitivity to antibacterial agents.
• Diuretics - Furosemide.
• Drugs that reduce intoxication and are administered through droppers - for example, saline solution, glucose.
• Antihistamines - Loratadine, Suprastin and others.
• Anti-inflammatory - Nimesulide, Naproxen, Diclofenac.
• Painkillers - “Promedol”, suppositories with belladonna.
• If necessary, anticoagulants are prescribed.
• Medicines to support the functioning of the cardiovascular system.
• Maintenance therapy, including taking vitamin complexes.
• Immunostimulating drugs.

After the symptoms of acute pelvioperitonitis are relieved, gynecology prescribes physiotherapy to prevent the formation of adhesions. These include:

• electrophoresis;
• laser therapy;
• ultrasound therapy;
• phonophoresis;
• massage;
• Exercise therapy.

Anti-adhesive therapy is also recommended, which includes taking enzyme-containing drugs - Lidaza, Hyaluronadase.

Disease prevention

Plastic pelvioperitonitis, if detected and treated in a timely manner, can be completely eliminated. Positive dynamics can be achieved by using complex therapy.

Active treatment tactics are the key to a quick recovery. Typical treatment procedures include puncture, laparoscopy and drainage.

This tactic increases the chance of subsequent pregnancies several times. With surgical intervention, the likelihood of conception and normal pregnancy is minimal.

After complicated pelvioperitonitis, the patient may be infertile. In most cases, there are problems with bearing a child. The risk of developing ectopic pregnancy and inflammation remains. Intense pelvic pain is often recorded.

To exclude factors contributing to the development of pelvioperitonitis, it is necessary to undergo a gynecological examination in a timely manner and eliminate possible diseases. Often the reason lies in long-term wearing of an intrauterine device, so it is necessary to strictly monitor the period of its use.

Prevention of possible complications and timely treatment will allow a woman to get rid of the inflammatory process and become pregnant.

Prevention of pelvioperitonitis includes the following:

• timely and complete treatment of diseases of the female genital area (inflammation of the appendages, endometritis, etc.);
• compliance with the rules of intimate and personal hygiene;
• exclusion of casual sexual relations;
• use of barrier methods of contraception to protect against sexually transmitted infections;
• regular visits to the gynecologist (at least 2 times a year).

Special attention should be paid to knowledge about sexually transmitted infectious diseases. The formation of an understanding of the problem is influenced by propaganda, including information such as:

• culture of sexual relations;

• the harm of abortion, especially at a young age;
• use of contraceptives;
• danger of hypothermia;
• timely registration during pregnancy, regular monitoring by a doctor.

One of the conditions for a woman’s health is a correct lifestyle and increased reactivity of the body. At the first signs of pelvioperitonitis, you should immediately consult a doctor. Timely treatment eliminates the dangerous complication of pelvioperitonitis. Outpatient treatment of chronic diseases of the pelvic organs must be carried out regularly and consistently.

Pelvioperitonitis is a disease whose likelihood can be minimized. It is enough to prevent acute inflammation of pelvioperitonitis. These include:

• Systematic visit to the gynecologist.
• Careful personal hygiene.
• A healthy lifestyle, including a balanced diet, quitting smoking and alcohol.
• Moderate physical activity. A culture of sexual life that excludes casual sex.
• Use of contraception.
• Timely detection and treatment of gynecological diseases, especially if they are associated with the development of an inflammatory process.
• Avoiding abortions and curettages.
• Complete cure for STDs, since, in most cases, they provoke the development of pelvioperitonitis.
• Treatment of chronic diseases of an infectious nature - tonsillitis, caries and others.
• Elimination of hypothermia.
• Timely registration during pregnancy and passing all necessary tests.
• Timely removal of the intrauterine device.

Surgery

If, when determining the cause of the symptoms, the diagnosis of pelvioperitonitis reveals the presence of a purulent process in the pelvic area, surgical intervention may be required.

Also, this method of treatment is used in the absence of effectiveness of antibacterial therapy, with a sharp deterioration in the patient’s condition or with the formation of a large number of adhesions.

Surgical treatment can be carried out in the following ways:

• Abdominal puncture, during which antibacterial and anti-inflammatory drugs are introduced into the body using a special device (puncture). Typically, about ten treatments may be required. The recovery period is short.
• Laparoscopy. In this case, the risk of postoperative complications is minimal.
• Abdominal surgery. It is carried out as a last resort when the infectious focus reaches its total size. There is a high risk of complications with this method.

Prognosis and possible complications

With timely and competent treatment, the pathology ends in complete recovery. After 8–10 days, a woman can return to her usual rhythm of life.

The best results in the fight against pelvioperitonitis are achieved with active tactics - drainage, laparoscopy, punctures.

In this case, the percentage of subsequent pregnancies is much higher than with conservative management.

Pelvioperitonitis in gynecology with timely treatment is completely curable and does not leave behind negative consequences. But if the disease is not diagnosed immediately and treatment is not prescribed, the consequences can be very dangerous.

• Infertility.
• Ectopic pregnancy.
• Purulent melting of the pelvic organs. This happens when the purulent process affects the pelvic organs. In this case, an emergency operation is performed in which the affected organs can be removed. For example, ovaries, tubes and uterus.
• Spread of inflammation. With pelvioperitonitis, the infectious focus is in the pelvic area. But without treatment, the inflammatory process can spread to the abdominal cavity.
• Sepsis. Infection through the bloodstream can spread to other organs and tissues. This is the most dangerous consequence of the disease, as it can be fatal.

Pelvioperitonitis in children

Girls are also susceptible to this disease. Typically, pathology is detected between the ages of three and seven years. The infection enters the peritoneum from the genitals. This happens because at an early age the protective environment in the vagina has not yet fully formed.

Pelvioperitonitis in girls can develop abruptly, with the manifestation of obvious symptoms - pain, high fever and others. But also signs of the development of the disease may resemble ARVI. The distinguishing factor will be vaginal discharge.

If you suspect an inflammatory process, you should immediately take your child to a pediatrician and pediatric gynecologist. Once you understand the causes and symptoms of pelvioperitonitis, making a diagnosis is not difficult.

Source: https://zeleno-mama.ru/ginekologiya/ostryy-pelvioperitonit-ginekologii/

Pelvioperitonitis at the present stage



Pelvioperitonitis is one of the pressing problems of modern gynecology, which accounts for 29% of the number of patients in the gynecological hospital.

The relevance of the topic is due not only to the high frequency of this pathology, but also to the fact that pelvioperitonitis can cause infertility, which leads to mental and social maladjustment, and a decrease in a woman’s professional activity.

The article discusses modern approaches to the diagnosis and treatment of pelvioperitonitis. Particular attention is paid to drug therapy.

Key words: pelvioperitonitis, mixed genital infection, antibacterial therapy, surgery, infertility.

Pelvioperitonitis is a local, limited inflammation of the parietal and visceral peritoneum of the small pelvis. Its development, as a rule, is preceded by PID, that is, this pathology more often occurs as a secondary process. The peak incidence occurs between 17 and 28 years of age [2].

PID is the result of an ascending infection and is associated with the following risk factors: frequent change of sexual partners and lack of barrier methods of contraception, long-term use of an IUD, a history of complications of the gestational period and childbirth, surgical interventions on the organs of the reproductive system. [5,6]. Pathogenetic factors include microorganisms such as Chlamydiatrachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, as well as yeast-like fungi of the genus Candida [1,5,6,8,10,13]. At the same time, representatives of the normal flora of the reproductive tract (Gardnerella vaginalis, Haemophylus influenza, Streptococcus agalactiae, gram-negative intestinal bacilli) play an important role in maintaining the inflammatory process [7]. Thus, PID is the result of a genital mixed infection [8].

Pelvioperitonitis occurs when an infection enters from the lower genital organs through the uterus and fallopian tubes into the abdominal cavity, as well as when the inflammatory process passes from the uterine appendages (with an existing inflammatory tubo-ovarian formation) to the pelvic peritoneum [3].

Diagnosis is based on identifying risk factors, clinical manifestations of the disease, data from instrumental and laboratory studies [3,4,8].

Ultrasound examination reveals free fluid in the pelvic area, weakening of peristaltic waves [3]. It is important to note vaginal dysbiosis.

For this purpose, studies are carried out such as light microscopy of fixed scraping material from the endocervix and vagina, as well as seeding of this material on nutrient media. Currently, the Femoflor 16 technology, based on the use of real-time PCR, is promising.

This technology allows us to give the most complete quantitative and qualitative characteristics of normal and opportunistic microflora of the urogenital tract of women. This method simultaneously identifies up to 25 difficult-to-cultivate microorganisms to species and determines their quantitative content [8].

A biochemical blood test reveals a statistically significant increase in the levels of macroglobulins, lactoferrin, and a decrease in the concentration of immunoglobulins compared to healthy women [4].

It is necessary to make a differential diagnosis of pelvioperitonitis with hemoperitoneum (ectopic pregnancy, ovarian apoplexy), diffuse peritonitis of surgical origin, appendiceal infiltrate, purulent tubo-ovarian formation, parametritis [3,12].

Drug treatment of pelvioperitonitis is aimed at stopping the inflammatory process and creating optimal conditions for the upcoming operation. Therapy should begin with antibacterial agents.

However, the prescription of drugs is done empirically, since determining the sensitivity of microbial pathogens that caused the pathological process to them is a lengthy and costly procedure [7]. Antibacterial therapy is based on an understanding of polymicrobial etiology and the close association with STIs [7,11].

In Russia, inhibitor-protected penicillins are used. They are active against opportunistic flora, including non-spore-forming anaerobes.

The most common representative of this group is amoxiclav, which is well tolerated and is available in parenteral and oral forms.

However, when using it, it is necessary to prescribe drugs that act on intracellular microorganisms, primarily azithromycin. Doxycycline should be used in the treatment of PID only if azithromycin cannot be used for any reason.

In the latest American guidelines, fluoroquinolones are not included in either recommended or alternative treatment regimens due to the widespread prevalence of resistant gonococci [10,11]. All treatment regimens must include metronidazole-containing drugs [1,6,7].

Treatment should begin with parenteral antibiotics. Subsequently, 24–48 hours after clinical improvement, a transition to oral administration is possible. Most authors believe that regardless of the type of antibiotic therapy (parenteral, oral), its total duration (pre- and postoperative period) should be no more than 14 days [7,11].

It is mandatory to prescribe antimycotic drugs in the complex treatment regimen for patients with pelvioperitonitis, which helps prevent the active proliferation of yeast-like fungi during the use of antibiotics [1]. It is important to increase the immunological resistance of the body [12].

Detoxification therapy (reopolyglucin, polyionic solutions, protein drugs, etc.), pain relief (diclofenac, etc.), administration of sedatives, vitamins, antihistamines and desensitizing drugs (chloropyramine, clemastine, calcium gluconate), anabolic steroids are also performed [3, 12].

Surgical intervention involves the following main tasks: elimination of the source of pelvioperitonitis, intraoperative sanitation and rational drainage of the abdominal cavity and pelvic cavity, drainage of the intestine in a state of paresis, the use of all means of eliminating intestinal failure syndrome [1,6,9].

Prevention of septic shock during surgery is carried out in all patients by simultaneous administration of antibiotics (a combination of penicillins with B-lactamase inhibitors, third generation cephalosporins) at the time of the skin incision [4,13].

In the postoperative period, all patients undergo intensive therapy, including the above-mentioned drug treatments, as well as heparin therapy, glucocorticoids (prednisolone in a daily dose of 90–120 mg with a gradual reduction in dose and discontinuation of the drug after 5–7 days), antiplatelet agents (chirantil, trental), hepatotropic drugs (essenseale, karsil), cardiotonics (cardiac glycosides, drugs that improve myocardial trophism), as well as drugs that improve brain function (nootropil, cerebrolysin) [1,6,7,9,11,12].

The absence or neglect of treatment can lead to the following dire consequences: the development of diffuse peritonitis, sepsis and the formation of adhesions in the pelvic area [2,5,8,10].

Complications include tubal-peritoneal infertility (formed due to organic or functional disruption of the patency of the fallopian tubes due to an inflammatory process), ectopic pregnancies, recurrent miscarriage, chorioamnionitis, placentitis, premature birth, postpartum endometritis, intrauterine infection of the fetus. Attempts at in vitro fertilization are often unsuccessful [1,5,6,7,8,9].

• Prevention of pelvioperitonitis involves timely detection of PID and adequate treatment [10,11].
• Thus, the issues of prevention, diagnosis, treatment and rehabilitation of patients with pelvioperitonitis remain very relevant, since this disease worsens the prognosis for the reproductive function of women, which is an important social and economic problem.
• Literature:

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2. Glukhova I.V., Abramova S.V., Vlasov A.P., Azisova A.M. Pathogenetic features of endogenous intoxication in pelvioperitonitis // Medicus. - 2016. - No. 2. - P. 28–30.
3. Kisileva N.I. Acute abdomen in gynecology: a manual //. — Vitebsk: VSMU, 2014. — pp. 127–131.
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8. Petrov Yu. A. Hysteroscopic characteristics of the endometrium of women with early reproductive losses // Bulletin of the Russian Peoples' Friendship University. Series: Medicine. - 2011. - No. S5. — pp. 243–247.
9. Petrov Yu. A. Microbiological determinants of chronic endometritis // News of higher educational institutions. North Caucasus region. Series: Natural Sciences. - 2011. -No. 6. -P.110–113.
10. Petrov Yu. A. Modern view on the treatment of chronic endometritis in cohorts with early reproductive losses // Bulletin of the Russian Peoples' Friendship University. Series: Medicine. - 2011. - No. 6. -S. 274–281.
11. Petrov Yu. A. Aspects of microbiological and immune diagnostics of chronic endometritis // Modern problems of science and education. 2016. -No. 4. - P.9.
12. Petrov Yu. A. The role of microbial factor in the genesis of chronic endometritis // Kuban Scientific Medical Bulletin. -2016. -No. 3. - pp. 113–118.

Key terms (generated automatically) : small pelvis, inflammatory process, antibacterial therapy, oral form, surgery, lower abdomen, III, genital mixed infection, abdominal cavity, postoperative period.

Source: https://moluch.ru/archive/126/35092/