The - inflammation of the tissue parauterine. Occurs most often after various interventions in the uterus (abnormal births, abortions, gynecological surgery). Pathogenic or conditionally pathogenic flora enters the parameter in the trauma of the uterus, or - less frequently - lymphogenous or hematogenous route from the adjacent foci of infection (adnexitis, endocervicitis, colpitis). After the introduction of infection in the parameters of the produced diffuse inflammatory infiltrate, which can fester (at the present level of care rarely happens), dissolve, or to acquire a chronic course. Infiltrate is usually located in certain areas, from the anterior neck to the lateral edges of the bladder to the anterior abdominal wall, from the anterolateral parts of the cervix - the crural arch and the lateral abdomen, posterolateral parts of the neck - to the walls of the pelvis, from the back of the neck - to direct intestine.
One of the first symptom is a persistent fever (with festering, it can take intermittent). Initially, the general condition of the patient is practically not changed, then there are growing signs of intoxication, and - headache, weakness, lethargy, weakness. There are complaints of a dull ache in lower abdomen, a feeling of pressure in the rectum can join dizuricheskie phenomena and difficulty of defecation.
In the blood of the patients are usually observed only persistent increase in ESR. With the development of abscesses infiltrate with neutrophilic leukocytosis occur shift to the left, dysproteinemia, etc. In bimanual study determined shortening and smoothing of the posterior or lateral vaginal vault, a more pronounced by the defeat (or uniformly - in total infiltration). The uterus is not fully contoured, as included in the inflammatory infiltrate in part or in whole.
Then the side of the uterus is defined infiltrate myagkovataya first, and later - a dense consistency. Signs of peritoneal irritation are absent. Palpation of the abdomen at the beginning of the disease is painless and maloboleznenna, when a festering belly to become sensitive to palpation. Complications can arise when late diagnosis of infiltration and the development of abscesses - a breakthrough of abscess in the free abdominal cavity, rectum, and bladder.
Treatment should begin with a broad spectrum antibiotic drug, or fluoroquinolone (ciprofloxacin) in combination with metronidazole for 5-7 days. The woman is on strict bed rest, cold, shown on the lower abdomen, intravenous infusion of calcium chloride and 150 ml of 3% solution. If festering abscess is opened through the posterior vaginal vault or from the anterior abdominal wall (extraperitoneal). With chronicity of the process can be used in daily prednisone dose of 20 mg for 10 days followed by NSAIDs, with normalization of blood parameters are shown in the lower abdomen ultrasound, light heat, candles with indomethacin. The disease is characterized long reverse development. After 4-6 months showed a spa treatment with the use of mud vaginal tampons, irrigation, or hydrogen sulfide baths, pelvic massage.