pelvic peritonitis
Introduction
Introduction to pelvic peritonitis Female pelvic genital inflammation, often accompanied by various degrees of pelvic peritonitis (pelvicperitonitis). Severe cases of inflammatory changes in the entire pelvic peritoneum, in very few cases can even diffuse to the whole abdomen, becoming diffuse peritonitis. Sometimes due to pelvic peritonitis or other organ inflammatory lesions in the abdomen, pus accumulates in the lowest part of the abdominal cavity - the uterine rectal fossa, and forms a uterine rectal abscess. The patient has high fever, chills, body temperature up to 40 ° C or above, severe abdominal pain in the lower abdomen, persistent, often nausea, vomiting, increased during activity; urination, pain during bowel movements, diarrhea or constipation, patients like to take The two legs are flexed horizontally to relieve tension and pain in the abdominal wall. In severe cases, irritability, systemic failure, and even unconsciousness, paralysis, and coma may occur. basic knowledge Sickness ratio: 4% Susceptible people: women. Mode of infection: non-infectious Complications: acute diffuse peritonitis
Cause
Causes of pelvic peritonitis
First, acute tubal inflammation disseminated acute inflammation of the fallopian tube, the pus in the lumen overflows through the abdominal cavity, or the direct spread of inflammation around the fallopian tube causes inflammatory lesions in the pelvic peritoneum.
Second, secondary to pelvic cellulitis.
Third, other surgical diseases such as appendicitis, perforation of diverticulitis.
The whole pelvic peritoneal congestion, a large amount of serous exudate containing fibrin, became chronic, the uterus, attachments and intestinal tubes were extensively adhered into a mass, and the omentum adhered from the pelvic entrance like a roof to other organs to form a package. Inflammatory mass, this adhesion has a certain self-protection effect, limiting inflammation to the pelvic cavity, avoiding diffusion to the whole abdomen, the absorption capacity of the pelvic peritoneum is lower than that of the upper abdomen, and can limit the absorption of toxins, but the adhesion gap still remains. Exudates are present, sometimes with multiple small abscesses left, and some can be completely absorbed, except for tight adhesions.
Prevention
Pelvic peritonitis prevention
1. Pay attention to hygiene. First of all, women should pay attention to health and sexual life after menstruation, postpartum, and abortion.
2. Avoid infection. For the flow of people, release of the ring, other uterine surgery and childbirth, should go to the regular hospital to avoid disinfection is not strict, artificially caused infection.
3. Keep your mood happy and pay attention to work and rest.
4. Sexual life is prohibited when there is bleeding in the vagina.
Complication
Pelvic peritonitis complications Complications, acute diffuse peritonitis
The Department of Complications developed diffuse peritonitis and uterine rectal abscess.
Symptom
Symptoms of pelvic peritoneal inflammation Common symptoms Peritonitis, high fever, and peritoneal peritonitis, diarrhea, irritability, blood pressure, slab, abdominal coma, cold sweat constipation
Because acute pelvic peritonitis is rarely primary, there is a history of acute pelvic organ inflammation before onset.
The patient has high fever, chills, body temperature up to 40 ° C or above, severe abdominal pain in the lower abdomen, persistent, often nausea, vomiting, increased during activity; urination, pain during bowel movements, diarrhea or constipation, patients like to take The two legs are flexed horizontally to relieve tension and pain in the abdominal wall. In severe cases, irritability, systemic failure, and even unconsciousness, paralysis, and coma may occur.
Signs: abdominal wall tension, rigidity, platy abdomen, severe tenderness and rebound tenderness, patients refused to press, especially the lower abdomen, so gynecological examination is impossible, even if the examination is not satisfied, the entire cervix, sputum tenderness is obvious, At this stage, doctors should not insist on double-checking. Severe patients may have shock, blood pressure drops, pale complexion, dry tongue, cold sweat, etc., and later collapse, heart failure, pulmonary edema, etc., according to the above clinical symptoms can be obtained Out of diagnosis, the number of white blood cells and neutrophils increased, and the erythrocyte sedimentation rate increased significantly.
In the chronic phase, the reproductive organs and the omentum can be touched, and the intestines stick to the uneven surface, the masses of different sizes, tenderness and fixation.
Examine
Examination of pelvic peritonitis
Physical examination: acute illness, fever, obvious tenderness in the lower abdomen, rebound tenderness, or plate-shaped abdomen, vaginal mucosa may be hyperemia changes, purulent secretions at the cervix, sputum tenderness during double diagnosis, if When the uterus rectal abscess is abscessed, the tenderness of the posterior iliac crest is more obvious, or it can touch the feeling of fullness, fluctuating, and the anal examination can feel the fluctuation and bulge in the anterior wall of the rectum.
Image diagnosis: Ultrasound examination: When there is an abscess formation, the B-mode ultrasound system can detect the mass, the contour is irregular, there is a dense echo around, and there is no echo zone inside.
Laboratory diagnosis: Abdominal and posterior malleolar puncture can extract liquid, mostly pale yellow, thin bloody liquid, yellow exudate or pus, can be sent to laboratory for testing or bacterial culture.
The number of peripheral white blood cells and neutrophils increased, and the erythrocyte sedimentation rate accelerated. Cervical secretions or blood cultures could produce pathogenic bacteria.
Diagnosis
Diagnosis and diagnosis of pelvic peritonitis
According to medical history, symptoms and signs, it is not difficult to make a diagnosis, but should be differentiated from acute appendicitis perforation. In addition, some diseases have symptoms similar to acute pelvic peritonitis, such as accessory tumor pedicle torsion, fallopian tube hematoma rupture, uterine fibroid necrosis, etc. Peritoneal irritation caused by severe abdominal hemorrhage (such as tubal pregnancy rupture), sometimes it is very difficult to distinguish from pelvic peritonitis, local signs of diffuse peritonitis, and a few pelvic peritonitis extended to the gallbladder caused by right upper quadrant pain and tenderness, and easy cholecystitis The signs are confused. In such cases, you should consult your medical history and refer to other conditions of the body (such as body temperature, blood pressure and general conditions) to get a diagnosis.
Chronic pelvic peritonitis often has chronic tubal oophoritis, chronic uterine myositis lesions, so there are often all symptoms of chronic pelvic genital inflammation, the treatment principle is exactly the same, no need to identify one by one.
