PARACOLITIS (paracolitis; grech, para near + colitis) — inflammatory process of pericolic area (paracolon) of retroperitoneal space.
is the cornerstone of P. infection of cellulose of paracolon at injuries, wounds and is especially frequent at destructive forms of an acute appendicitis when the worm-shaped shoot is located retrotsekalno or retroperito-nealno. The disease can develop at phlegmonous damage of a large intestine, at the vnebryu-tire perforation of its wall arising against the background of a cancer ulcer, nonspecific ulcer colitis, a disease Krone, an amebiasis, a typhoid, dysentery and also at perforation of a gut foreign bodys, extra peritoneal perforation of ulcers of a duodenum.
Secondary infection with a lymphogenous or hematogenous way is observed seldom. Nevertheless it is necessary to reckon with a possibility of such course of a disease in spite of the fact that suppurative focuses (a furuncle, abscess, a felon, etc.) are localized sometimes in a considerable distance from paracolon.
Inflammatory process more or less long time has local character. However, according to V. F. Voyno - the Dittany - whom (1946), at its progressing can happen purulent fusion of the delimiting pases-rakolon of fascial partitions to development of diffuse phlegmon retroperitoneal space (see), and further, at destruction of a pleura or a peritoneum — purulent pleurisy (see) or peritonitis (see). Pus can spread along a neurovascular bunch to a hip, on a vagina of an iliolumbar muscle to a trochantin, through a lumbar triangle (breviers a triangle) under skin of a rump and on a front surface of a sacrum in a small pelvis; through a big sciatic opening in gluteuses, and through a locking opening in thickness of adductors of a hip.
The clinical picture
because of the absence of accurate a wedge, symptoms a disease is seldom diagnosed in early stages. Usually only to 3 — to the 5th day abdominal pains or in lumbar area, irradiating to the inguinal area, a hip, area of a hip joint appear. At suppuration of inflammatory infiltrate and formation of abscess or phlegmon there are tremendous oznoba which are followed by fervescence to 39 — 40 ° and pouring sweats. Progressively symptoms of intoxication accrue. On 7 — the 8th day in the relevant side department of a stomach begins to be defined the dense, usually motionless, painful infiltrate of a kolbasovidny form spreading up from a crest of an ileal bone. Development in most of patients of a psoas symptome is characteristic (see. Psoitis ).
Mistakes in P.'s diagnosis, according to R. S. Shpizel (1971), reach 50 — 70%. Recognition is helped by carefully collected anamnesis and detection at a sick disease, against the background of to-rogo there can be P. Dostoverny a diagnosis becomes at identification of infiltrate and characteristic changes in blood (a high leukocytosis with shift of a formula of white blood to the left, the accelerated ROE).
It is necessary to differentiate P. from intraperitoneal and pelvic abscesses, osteomyelitis of ileal bones, paranephritis (see) and pyonephrosis (see), appendicular infiltrate (see. Appendicitis ), epiphrenic abscess (see).
When P.'s diagnosis is made presumably, before emergence of the expressed infiltrate, the intensive antibacterial care including antibiotics of a broad spectrum of activity in combinations with streptocides and physiotherapeutic procedures is shown.
The main method of treatment of purulent P. — operational with the subsequent elimination of the reason which caused it. If P. arises as a complication of cancer, nonspecific ulcer colitis, disease Krone of a large intestine, appendicitis or owing to perforation of a gut the swallowed foreign body, then operation should be made dvukhmomentno: to open purulent accumulation, and the intervention directed to elimination of its source, to delay. Opening of an abscess is most often made under the general anesthesia by a slanting iliolumbar extra peritoneal section on Bergmanna — Izra-elyu applied usually in urology to an exposure of kidneys and ureters. Also cuts across Pirogov or on Voy-no-Yasenetskomu are widely used. Make broad opening of an abscess with careful audit of his cavity, eliminate everything flow and drain. An operative measure is combined with purposeful antibacterial therapy, holding disintoxication actions and active complex fortifying treatment.
The forecast and Prevention
the Forecast is defined first of all by weight of a course of a disease, against the background of to-rogo P., virulence of an infection, and also existence of the general or local complications developed. At timely opening of an abscess the forecast, as a rule, favorable.
Prevention: timely elimination of the centers of a purulent infection in an organism and pathogenetic therapy of the diseases promoting development of the Item.
Bibliography: Voyno-Yasenetsky V. F. Sketches of purulent surgery, D., 1956; To at shch JI. N, And with and e in A. V. and Kramarenko V. L. Acute purulent diseases of retroperitoneal space at children, Klin, hir., No. 12, page 25, 1974; Popkirov S. It is purulent - septic surgery, the lane with bolg., Sofia, 1977; Sh p and z e of l R. S. Acute inflammatory diseases of cellulose of retroperitoneal space, Surgery, No. I, page 59, 1971.
V. V. Sergevnin.