Ovary abscess (пиовар)

Description:

Piovar develops at penetration of pathogens into ovarian fabric in the intrakanalikulyarny, lymphogenous or hematogenous way. The acute inflammation of a stroma of a bast layer of an ovary leads to a local circulatory disturbance, hypostasis, focal or diffusion inflammatory infiltration with the subsequent formation of abscesses of an ovary. Merge of purulent cavities promotes fusion of ovarian fabric and transformation of an ovary into the meshotchaty education filled with pus – пиовар. Localization of a piovar usually unilateral.
As activators of purulent processes in ovaries serve aerobes (энтерококк, staphylococcus, e. Coli, streptococci, gonokokk), anaerobe bacterias (peptokokk, bacteroids, peptostreptokokk), gram-negative microorganisms (proteas, a klebsiyell) and their associations. Piovar can be spliced with basin walls, a pipe, a uterus, an epiploon, a bladder and loops of intestines. The break of a piovar in a free abdominal cavity and the next hollow bodies (a rectum, a bladder, a vagina), formation of pelvic abscesses, development of a parametritis, pelviperitonitis, diffuse peritonitis is in rare instances possible.

Reasons of abscess of an ovary (piovar):

In a pathogeny of a piovar the intrakanalikulyarny (ascending) way of infection from the genital and extragenital centers prevails; less often the infection extends gematogenno or limfogenno. Piovar usually is a complication of inflammatory diseases – a cervicitis, an endometritis, a salpingitis, a salpingo-oophoritis, an oophoritis.
Quite often formation of a piovar is preceded by carrying out various gynecologic operations: a vulval hysterectomy, a resection of an ovary, a scraping of a cavity of the uterus, abortion (especially criminal abortions), Cesarean section, bandaging of uterine tubes, a salpingectomy, a transvaginal puncture of follicles of ovaries at EKO, etc. Besides, existence of Naval Forces increases risk of development of a piovar and a pyosalpinx by 4 times. In some cases пиовар develops owing to a rupture of a cyst of a yellow body or a follicular cyst.
As premorbidal background for development of a piovar conditions of an immunodeficiency, an endocrinopathy (hyper - and a hypothyroidism, a diabetes mellitus), somatopathies (anemia, infections), social and behavioural factors (a stress, alcoholism, drug addiction, early or chaotic sexual bonds), cystous educations can serve in ovaries, etc.

Symptoms of abscess of an ovary (piovar):

The clinical picture of a piovar is characterized by an all-inflammatory syndrome, local inflammatory changes and intoxication.
The clinic of a piovar demonstrates from rise in high temperature, gektichesky fever, a fever, perspiration, tachycardia, sharp weakness, a sleep disorder and appetite. In the bottom of a stomach the acute throbbing pain amplifying at any exercise stress is noted during periods, defecations, sexual intercourse. Dysuric and dispeptic disturbances are characteristic; appear putreform bleach from a genital tract.
Against the background of a piovar and a pyosalpinx the uniform inflammatory conglomerate – tubo-ovarian abscess is quite often formed. At development of a pelviperitonitis symptoms of irritation of a peritoneum join.

Treatment of abscess of an ovary (piovar):

Treatment tactics which the modern gynecology applies at patients with piovary includes radical removal of a suppurative focus, suppression of infectious process, hospital and post-hospital rehabilitation.
In the preoperative period antibacterial, anti-fungal, anti-protozoan agents are appointed; carry out the disintoxication therapy immunostimulating therapy (UFOK, VLOK), hemosorption, a plasma exchange.
At a surgical stage removal is made it is purulent - the destructive center. Palliative interventions at a piovara (a colpotomy, an abscess puncture) are justified in case of high probability of perforation of an abscess in an abdominal cavity, its break in hollow bodies or at the general weight of a state.
As radical intervention at a piovara at young women serves the unilateral adneksektomiya – removal of the inflammatory changed appendages in the laparoscopic or laparotomichesky way. At women in a postmenopause performance of supravaginal amputation or a hysterectomy with appendages is considered optimum.
At a secondary pelviperitonitis and peritonitis after removal it is purulent - necrotic fabrics the prolonged drainage of an abdominal cavity with carrying out peritoneal dialysis is carried out.
At a stage of rehabilitation physiotherapeutic courses are conducted: UZT, ультрафонофорез, microwave therapy, magnetotherapy, electrophoresis, laser therapy, mud cure, hydrosulphuric bathtubs and so forth.

Diagnosis:

Recognition of a piovar in gynecology demands an integrated approach: carrying out a gynecologic research, ultrasonography, bacteriological crops of a smear on flora, a diagnostic laparoscopy. Information on the inflammations of internal genitalias or the postponed gynecologic interventions which are available for the patient gives help in diagnosis of a piovar.
Shifts in the general blood test at a piovara are characterized by a leukocytosis, acceleration of SOE (to 80 mm/h and above). The bacteriological research separated from a vagina allows to identify contagiums and to begin antibacterial therapy.
Vaginal examonation promotes identification more often than the unilateral tumorous painful education having the dense capsule and indistinct borders because of an union with surrounding bodies (an epiploon, intestines loops, a bladder).
According to gynecologic ultrasonography пиовар it is visualized in the form of ekhopozitivny roundish education with heterogeneous internal contents because of multiple inclusions, unevenly reinforced capsule (6-10 mm).
In doubtful cases performance of a puncture of a back vault of the vagina, diagnostic laparoscopy is required.
Piovar during diagnosis differentiate with an acute appendicitis, cholecystitis, intestinal impassability, peritonitis, pyelonephritis, an acute salpingo-oophoritis.

Complications:

At perforation of a piovar and izlitiya of pus purulent peritonitis develops in an abdominal cavity.
When emptying an abscess the inflammation (a rectitis, a sigmoiditis, cystitis, a colpitis) develops in hollow bodies, adjacent to a piovar, – a direct or sigmoid gut, a bladder, a vagina in them, form is long not closed fistulas. The current of a rectitis and a sigmoiditis is characterized by tenesmus, mucifyings, ponosa. At cystitis painful and frequent desires to an urination develop; the vaginitis is shown by purulent discharges from a genital tract.