Intra belly abscesses

Description:

Abscess it is possible to call only suppurative education with the dense inflammatory capsule containing viscous pus. Unlike it, the kontamina-tsionny or infected liquid which is freely spreading in a stomach or its local accumulations without strong capsule — the evidence of the continuing process of contamination or infection, but not abscess.

Symptoms of Intra belly abscesses:

All variety of intra belly abscesses can be reflected in their such classification. It is almost important to allocate 4 groups of abscesses: visceral (for example, hepatic and splenic) or not visceral (subphrenic, pelvic), intraperitoneal or extra peritoneal. Not visceral abscesses are a consequence of diffusion peritonitis which sometimes at a final stage has an appearance of the separate delimited purulent accumulations, or happen a consequence of perforation of hollow bodies which were delimited by unions. As the reason of visceral abscesses serves hematogenous or lymphogenous dissimination of bacteria in parenchymatous bodies. Retroperitoneal abscess can be result of perforation of hollow body in retroperitoneal space or arise in the hematogenous or lymphogenous way.

Other approach in differentiation is division of abscesses on postoperative for which emergence we, surgeons, have sense of responsibility, and spontaneous, not connected with any previous operation. Great clinical value has also division of abscesses on simple and difficult multiple, multifocal, connected with fabric necroses, intestinal fistulas or tumors) which demand more aggressive tactics and are characterized by the worst forecast.

The anatomic classification based on a certain typical localization of abscesses in this or that area considerably lost the value with implementation of modern diagnostic aids and technology of transdermal drainage of abscesses.

Abscesses are as if the intermediate natural result of contamination or an infection. On the one hand, the infection remains and even develops, and with another — process is delimited by mechanisms of protection of an organism of the owner, helping your treatment. Natural outcomes of abscesses lie outside human opportunities as peritoneal protection is effective only partially; it collapses excess quantity of bacteria, a fabric hypoxia and acidosis, and also adjacent destructive elements — such as nekrotizirovanny fibrin, detritis, hematomas or extra organ barium. Intra belly abscess will not kill your patient at once, but without treatment (without drainage) gradually it becomes deadly to the patient if only it is not opened and will not be emptied independently.

Clinical displays of intra belly abscesses are so many-sided, as well as abscesses. The range of clinical manifestations is quite wide - from strong indications of septic shock before "absolutely any manifestations" in the conditions of the suppressed immunity and treatment by antibiotics.

Locally abscess can be palpated through an abdominal wall, at a rectal or vaginal research, however in most cases inflammatory абсцеди-рующая the structure remains unavailable to a physical research.

Presently, when any temperature increase is considered as the indication to treatment by antibiotics, the majority of real abscesses first "were cured partially" or disguised" and further appeared already in the form of SIRS with different degree of multiorgan insufficiency. Paralytic Ilheus is one more frequent symptom of abdominal abscess; in a postoperative situation it is that Ilheus which is not allowed.

Reasons of Intra belly abscesses:

Intra belly abscesses develop owing to active protection of an organism of the owner and represent rather favorable outcome of peritonitis.
Bacteriology of abdominal abscesses polymicrobial. Abscesses which develop as an outcome of secondary peritonitis (for example, appendicular or diverticular abscess) differ in the mixed aerobic and anaerobic flora characteristic of secondary peritonitis.

In particular, if such facultative anaerobe, as emitting endotoxin E. coli, causes development of diffusion peritonitis, strict anaerobes (for example Bacteroides fragilis) tend to formation of late abdominal abscesses. These bacteria work synergistically: both look participate in formation of abscess, but existence of strict anaerobes increases probability of a lethal outcome.

The prevailing majority of visceral abscesses (hepatic and splenic) polimikrobna: aerobic, anaerobic, gram-negative and gram-positive. Told fairly and for retroperitoneal abscesses. But primary abscesses often of a monobakterialna, and prevail staphylococcus. Postoperative abscesses are, as a rule, characterized by microflora, typical for tertiary peritonitis, presenting themselves superinfection in the form of drozhzhepodobny mushrooms and other opportunistic microflora.

Low virulence of these microbes which are a peculiar marker of tertiary peritonitis reflects full immune insolvency of the observed patient.

Treatment of Intra belly abscesses:

All intra belly abscesses have to be trained; at the remaining source of an infection it is extremely important to add treatment with antibiotics.
Antibiotics at treatment of intra belly abscesses

Actually there are no proofs that in addition to full evacuation of pus from an abscess cavity in general any antibacterial agent is necessary. Remember old kind times (though since then there passed not much years) when pelvic abscesses observed before full "maturing" and then drained through a back vault of the vagina or a rectum; recovery occurred quickly and was full without any antibiotics. However the modern standard of treatment is that if there are serious reasons for the diagnosis of abscess, antibacterial therapy has to be appointed. Originally it has to include antibiotics of a usual polymicrobial range, and after identification of the activator the antibiotic can be replaced or its dose is reduced.