Parametritis – inflammation of the tissue surrounding the uterus. Occurs when the infection spreads from the uterus after childbirth, abortion, curettage of the uterine mucosa, operations on the cervix, when using the IUD. Infection penetrates the parametric tissue lymphogenous way. Parametritis begins with the onset of infiltration and the formation of serous inflammatory exudate at the site of injury. With a favorable course of infiltration and exudate dissolve, but in some cases, fibrous connective tissue develops at the site of inflammation, which leads to the displacement of the uterus towards the lesion. When suppuration of the exudate occurs purulent parametritis, which can be resolved by the release of pus in the rectum, at least – in the bladder, abdominal cavity.
The clinical picture of parametritis is caused by inflammation and intoxication: fever, headache, feeling unwell, dry mouth, nausea, abdominal pain radiating to the leg or lower back. Sometimes parametrium infiltration leads to compression of the ureter on the affected side, impaired passage of urine, and even the development of hydronephrosis. In the diagnosis of the disease, an important role is played by a bimanual and rectovaginal examination, which determines the smoothness of the lateral vaginal fornix, the dense, fixed, low-painful infiltration of the parametrium at the site of the lesion, sometimes reaching the pelvic wall. Percussion over the superior anterior iliac spine on the side of the parametritis reveals a dull percussion sound (Henter’s symptom). In the blood, there is a leukocytosis with a shift of the leukocyte formula to the left, an increase in the ESR. Additional diagnostic methods for parametritis are ultrasound of the pelvic organs, CT and MRI.
With suppuration of parametric fiber, the patient’s condition deteriorates dramatically – chills appear, hectic fever, symptoms of intoxication increase. In the case of the development of fibrotic changes in the field of parametrium, a dense cord is palpated, the uterus is displaced towards the lesion.
Gynecological peritonitis (diffuse peritoneal lesion) along with sepsis is the most severe form of manifestation of the inflammatory process of the internal genital organs and is characterized by symptoms of severe endogenous intoxication and multiple organ failure, referred to as sholnitelnogo toxin syndrome.
In the development of peritonitis, it is customary to distinguish 3 stages: reactive, toxic, and terminal. The reactive stage, which lasts for about a day, is characterized by —hyperemia, * peritoneal edema, —exudation with the formation of fibrin, impaired permeability of vessels with hemorrhagic manifestations of varying intensity, as well as signs of initial intoxication. On examination, patients are agitated, complain of pain throughout the abdomen, aggravated by a change in body position, an increase in body temperature; chills, nausea, vomiting. On examination, the skin is pale with a gray tinge, tachycardia is noted, the tongue is dry, coated with bloom. The abdomen is tense, its palpation is sharply painful in all departments, positive symptoms of peritoneal irritation, intestinal peristalsis is slowed down. In blood tests, moderate hysteritis with a shift to the left is detected. In the toxic stage, which lasts about 2 days, symptoms of intoxication increase, and local manifestations of peritonitis become less pronounced. The condition of the patients is severe, they become lethargic, adynamic. Repeated vomiting and pronounced intestinal shear lead to violations of water and electrolyte balance, acid-base property, to hypo-and dysproteinemia. Leukocytosis with a shift to the left is growing. In the terminal stage, occurring in 2–3 days, symptoms appear that indicate a deep lesion. The central nervous system, the patients’ consciousness is confused, the features are pointed, the skin is pale gray, cyanotic. with drops of sweat (Hippocrates face). Symptoms increase prliorgannogo failure. Pulse becomes weak, arrhythmic, hypotension and bradycardia, marked shortness of breath, oliguria, vomiting, stagnant contents, constipation is replaced by diarrhea.