EMPYEMA (empyema; Greek empyema an abscess) — considerable accumulation of pus in hollow body or a perigastrium. The term «empyema» is applied with the indication of the struck body or a perigastrium. AA. it is necessary to distinguish from abscess (see), to-ry is located in the thickness of fabrics and it is limited by a piogenic membrane. In nek-ry cases instead of the term «empyema» use the term consisting of a terminoelement pio-(the containing pus, purulent) and names of the struck body (cavity), napr, Pío of meter, a pyothorax, a pyosalpinx.
Reason E. hollow bodies (e.g., a gall bladder, a worm-shaped shoot, a fallopian pipe, an ureter) the purulent inflammation most often is, at Krom outflow of pus owing to hypostasis of a mucous membrane, obturation of a gleam of an output channel of body by concrements, formations of cicatricial banners, etc.
E is broken. a pleura most often results from distribution of a purulent inflammation from pulmonary fabric, AA. a joint cavity — at penetration of pus from an epiphysis of a bone or at hit in a joint of small foreign bodys owing to its wound.
Morfol. changes at E. correspond to a picture of a purulent inflammation. At the long and heavy course of inflammatory process mucous (synovial or serous) the cover, and then the fabrics more deeply lying can be partially or are completely destroyed. In these cases the wall of a purulent cavity is formed by granulyatsionny fabric of various degree of a maturity, thickness of a layer a cut can reach
4 — 6 cm
Klin, the picture is defined by localization of defeat (see Appendicitis, Arthritises, Antritis, the Metroendometritis, Pleurisy, Cholecystitis).
To complications E. a hollow abdominal organ development of acute peritonitis belongs (see). At E. a joint defeat of all its elements and surrounding fabrics is possible (see the Panarthritis). At an empyema of a pleura emptying of an abscess can happen through a bronchial tube or through the melted fabrics of a chest wall (so-called empyema necessitatis). However it seldom leads to spontaneous treatment; usually process accepts hron. a current in connection with formation of the residual (not falling down) purulent cavity.
Diagnosis E. bodies and perigastriums put on the basis of data a wedge, inspections of patients and results of special methods of a research. Diagnosis E. pleurae and AA. joints establish by means of auscultation, percussions, to a palpation, rentgenol. research and trial puncture. The pyosalpinx is diagnosed at detection during bimanual vaginal examonation of painful formation of oblong shape of an elastic consistence in the affected uterine tube and existence for the patient of manifestations of the general reaction of an organism to purulent process (see. Purulent infection). The general reaction to purulent process in combination with the expressed peritoneal symptoms often allows to differentiate an empyema of a gall bladder with his edema (see Cholelithiasis, the Gall bladder). Existence of an empyema of a worm-shaped shoot at an acute appendicitis before operation usually is not distinguished.
Treatment only operational. The affected abdominal organ is subject to removal. Only at an empyema of a gall bladder extensive commissures and critical condition of the patient sometimes force to be limited to imposing of outside fistula on a gall bladder; in nek-ry cases the laparoscopic cholecystostomy is possible (see the Cholecystostomy). Fistula is imposed temporarily counting upon repeated radical intervention. The empyema of a joint demands an urgent arthrotomy (see). At an empyema of a pleura treatment is begun with aspiration of pus by punctures, in the absence of effect passed to constant aspiration drainage (see), a cut in some cases combined with flowing washing of a pleural cavity antiseptic solutions. These actions together with vigorous antibacterial therapy allowed to narrow considerably at an empyema of a pleura indications to the pleurotomy which was widely applied earlier (see Pleurisy).
The forecast at E. bodies and perigastriums depends on character, localization of process, and also timeliness and full value of treatment. Education E. burdens a current and worsens the forecast of a disease, against the background of to-rogo it developed.
S. A. Rusanov.