suppurative pelvic thrombophlebitis
Introduction
Introduction to suppurative pelvic thrombophlebitis Suppurative pelvic thrombophlebitis is a thrombus caused by bacterial invasion of the venous intima of the pelvic infection site. When the blood clot is further infected, it forms a suppurative pelvic thrombophlebitis. Suppurative pelvic thrombophlebitis is a serious Complications of pelvic infection. basic knowledge The proportion of illness: 0.002% Susceptible people: good for pregnant women Mode of infection: non-infectious Complications: sepsis
Cause
Causes of suppurative pelvic thrombophlebitis
(1) Causes of the disease
Can be seen after pelvic surgery infection, a small number of cases of fallopian tube ovarian abscess, the most common in puerperal infection and abortion infection, mainly caused by anaerobic bacilli and anaerobic infection, bacteria and their endotoxin directly through the damaged blood vessels Endothelial cells activate factor VIII and initiate the internal coagulation system.
(two) pathogenesis
Suppurative pelvic thrombophlebitis usually occurs first in limited pelvic cellulitis, occasionally thrombosis in the venous blood vessels, starting in the uterine wall, gradually expanding to the uterus and ovarian veins, followed by infection of the internal iliac vein and pelvic multiple sites Thrombosis, which extends along the intima of the blood vessel or spreads through the lymphatic vessels around the vein. Intra-orbital vein-infected thrombus extends along the iliac vessels to the common iliac vein, and then to the inferior vena cava, which can also expand in the opposite direction, resulting in femoral vein embolization. As long as the blood clot is fixed to the vein wall, it will not endanger the patient's life. However, if some blood clot breaks and is infused into the blood, it can die due to pulmonary embolism. Since the thrombus contains bacteria, the bacterial endotoxin can cause platelet aggregation and thrombosis. The mechanism may be: increased cytosolic calcium concentration, activation of myosin light chain kinase, platelet deformation, protein kinase C activation and glycoprotein III phosphorylation leading to changes in the conformation of fibrinogen receptors on the platelet membrane Thrombosis, under the action of bacteria, liquefaction occurs as fragments, which fall into the systemic blood circulation and cause sepsis The infected clot fragments eventually stay in the lungs, kidneys, brain, liver, and even heart valves and skin, causing local infections.
Prevention
Suppurative pelvic thrombophlebitis prevention
Prevent infection after pelvic surgery, puerperal infection and abortion infection.
Complication
Complications of suppurative pelvic thrombophlebitis Complications sepsis
Suppurative pelvic thrombophlebitis can be recurrent septic infarction, fulminant sepsis and fatal if not controlled in time.
Symptom
Suppurative pelvic thrombosis venous symptoms Common symptoms Severe pain High fever Cold war pulse Fine venous reflux disorder Venous thrombosis Skin temperature reduction
High fever, up to 40 ~ 41 ° C, is a relaxation type, high time, low time, great fluctuations, and frequent recurrent attacks, often accompanied by chills, pulse speed, continuous increase, most only mildly Abdominal pain, if severe pain and snoring in the upper right quadrant and rib angle area, ovarian venous thrombophlebitis should be considered.
Due to the lack of typical clinical manifestations of this disease, the diagnosis is more difficult, except that the autopsy can be clearly confirmed, it can only be speculated based on the general clinical manifestations.
Examine
Examination of suppurative pelvic thrombophlebitis
1. Blood routine, blood sedimentation examination.
2. Blood culture
When high fever, blood is drawn for general bacterial culture, often negative, occasionally hemolytic streptococcus, Escherichia coli positive, but anaerobic culture can be found in anaerobic streptococci and fragile bacillus.
3. Drug sensitivity test.
4. X-ray chest X-ray: may provide clues, such as pulmonary infarction or lung abscess, it is helpful for diagnosis.
5. Doppler ultrasound blood flow image examination can understand whether the vein is smooth, with or without thrombosis.
Diagnosis
Diagnosis and diagnosis of suppurative pelvic thrombophlebitis
Diagnostic criteria
History
Unexplained hyperthermia after surgery or 3 to 21 days postpartum, repeated chills and relaxation-type hyperthermia, rapid pulse rate, other serious infections and objective indicators, but abdominal symptoms are blurred, usually treated with effective antibiotics failure.
2. Signs
The pelvic examination can be found without abnormality. The pelvic floor is generally tender. A few can touch the hard and tender cord in the accessory area of the uterus, or the nodular thickening. In addition to the above signs can be used as a diagnostic reference. In the vein of the pelvic wall vascular branch, the position is low, it is not easy to find the lesion area during gynecological examination, such as tenderness in the deep side of the pelvic side wall, or thickening of the affected side lower limb, whitening, lower skin temperature, pain, help In the diagnosis, due to the spread of infectious thrombus to the femoral vein, the entire affected side of the lower extremity venous return disorder, the formation of "white femoral swelling" and the above signs, pelvic examination can cause acute high fever, local lesions are stimulated, for infection of blood coagulation The block enters the bloodstream and causes sepsis.
Differential diagnosis
Should be differentiated from acute suppurative appendicitis.
