Piovar
Piovar is classified as an inflammatory disease of the female genital organs, widespread destruction of ovarian tissues due to suppuration (translated from Latin pus — pus + ovarium — ovary), as a rule, piovar occurs due to a purulent inflammatory process in the fallopian tubes, localized more often on one side.
The content of the article:
Etiology of piovar
Symptoms of piovar
Piovar treatment
Forecasts and prevention of piovar
Piovar
A purulent cavity is formed in the ovary, the ovarian wall is covered with granulation and connective tissue, an abscess is formed. The baggy formation that appeared as a result of such processes is called a piovar. Tubovarial abscess occurs in most cases. More than one third of acute manifestations of piovar are preceded by a chronic course of the disease, untimely treatment.
Ovarian inflammation is a disease invisible to others, but very dangerous, especially for young girls.
Etiology of piovar
Piovar occurs after the penetration of pathogenic microorganisms into the ovarian tissue by hematogenic, lymphogenic or intracanalicular pathways. In a normal state, the appendages of the ovaries and the ovaries themselves are sterile.
The standard pathogens of piovar are anaerobes (peptostreptococci, peptococci, bacteroids), aerobes (gonococcus, staphylococcus, streptococcus), gram-negative microorganisms (klebsiella, proteus), as well as their associations.
Piovar can be soldered to the uterus, pelvic walls, tube, omentum, intestinal loops and bladder. In some cases, poivar can perforate into the abdominal cavity and adjacent abdominal organs (vagina, bladder, rectum), form a pelvic abscess, peritonitis, pelvioperitonitis, diffuse peritonitis, which are characterized by severe course.
The etiology of piovar is dominated by the intracanalicular pathway of infection from genital as well as extragenital foci. Piovar is very often a consequence of various inflammatory diseases: endometritis, cervicitis, oophoritis, salpingoophoritis.
Sometimes piovar is a complication after various surgical interventions, such as ovarian resection, vaginal gitrectomy, artificial termination of pregnancy (often criminal abortion), tubal ligation, cesarean section, transvaginal puncture of ovarian follicles during IVF, salpingectomy, etc.
The background for the occurrence of piovar may be concomitant untreated somatic diseases, immunodeficiency, endocrinopathy (diabetes mellitus, hypo- and hyperthyroidism), behavioral and social factors (promiscuous sexual relations, stress, alcoholism, drug addiction in the past), the formation of cysts in the ovaries and other uterine pathologies.
Symptoms of piovar
External manifestations of piovar are sharp, pulling pains in the iliac region, dyspeptic and dysuric disorders, fever, sweating, abundant discharge of whites, general intoxication, sleep disturbance. The pain increases with physical exertion, during sexual intercourse, menstruation, defecation.
With acute inflammation of the stroma of the cortical layer of the ovary, edema appears, local circulatory disorder, diffuse or focal inflammatory infiltration, then the formation of piovar may begin.
Examination of the uterus and appendages using instrumental methods makes it possible to clearly determine the localization, as well as the size of the piovar.
It is possible to identify piovar with the help of diagnostic laparoscopy, intravaginal examination, ultrasound, laboratory methods, as well as diagnostic laparoscopy.
The easiest way to diagnose piovar is considered a vaginal examination. With the help of a vaginal examination, a unilateral tumor-like formation, painful on palpation, is most often determined. The formation of piovar has fuzzy boundaries due to adhesions with adjacent organs (bladder, omentum) and a dense capsule.
During gynecological ultrasound, the piovar appears in the form of a rounded echopositive formation, the contents of which are heterogeneous. The thickening of the capsule looks uneven (6-10 mm).
In controversial cases, it is also recommended to perform a puncture of the posterior vaginal arch (diagnostic laparoscopy).
It is also worth paying attention to laboratory indicators. Regarding blood parameters, the acceleration of erythrocyte sedimentation time (ESR) to 80 mm/h and above and leukocytosis is characteristic for piovar, which is a direct indicator of the inflammatory process. With the help of bacteriological seeding from the vagina, it is possible to determine the flora and sensitivity to antibacterial drugs, which will help to choose the right concomitant antibiotic therapy necessary to eliminate piovar.
During diagnosis, it is important to differentiate piovar with peritonitis, intestinal obstruction, acute appendicitis, pyelonephritis, salpingoophoritis.
Piovar treatment
Piovar’s treatment tactics, provided for by modern gynecology, consists of radical surgical intervention, hospitalization, drug therapy and post-hospital rehabilitation.
The preoperative period includes antibiotic therapy, taking antimycotic, antiprotozoal drugs. Also mandatory for the treatment of piovar is detoxification treatment, immunostimulating therapy (VLOK, UFOK), plasmapheresis, hemosorption.
Developing sepsis, perforation of purulent contents, intra—abdominal abscesses and other severe forms of purulent inflammatory processes in the uterus and appendages are direct indications for surgical intervention.
The stage of surgical interventions is to eliminate the purulent focus. Palliative piovar treatments (puncture of an abscess, colpotomy) are used in case of a high probability of an abscess breakthrough into the abdominal cavity, its perforation into hollow organs, or with the general severity of the condition.
Also, the choice of treatment tactics depends on the age of the patient. For young girls, unilateral adnexectomy (removal of the affected appendages), laparotomy or laparoscopic methods have an advantage. For postmenopausal women diagnosed with piovar, extirpation of the uterus with appendages or supravaginal amputation is indicated. When the appendages of the uterus are removed, they are bandaged, then the ligament on which the ovary is suspended is crossed.
In case of complications of piovar from the abdominal cavity (peritonitis, pelvioperitonitis), after removal of necrotic tissues, long-term drainage of the peritoneum is performed, followed by peritoneal dialysis.
During the rehabilitation period, patients undergo physiotherapy courses — magnetotherapy, electrophoresis, ultraphonophoresis, laser therapy, hydrogen sulfide baths.
Forecasts and prevention of piovar
Given the level of modern medicine and gynecology, the prognosis for piovar is more often favorable, but everything depends on timely prevention, diagnosis, as well as determining the appropriate therapy. But, unfortunately, there are cases of severe piovar, complicated by its perforation, the outpouring of pus into the abdominal cavity and the development of purulent peritonitis.
When the piovar breaks and its contents are moved to the adjacent organs — the vagina, bladder, rectum or sigmoid colon, the organs are involved in the inflammatory process (cystitis, sigmoiditis, colpitis, rectitis), fistulas are formed that do not close for a long time. Sigmoiditis and rectitis, which are a complication of piovar, are characterized by mucus secretions, diarrhea, tenesmus. Cystitis is accompanied by frequent and painful urge to urinate. Purulent discharge from the genital tract accompanies vaginitis. Inflammation of the peritoneum of the pelvis can also occur as a result of piovar. High risk of infertility due to scarring in the pelvis.
The prevention of piovar includes timely preventive medical examinations, proper treatment of genital infections, prevention of complications as a result of surgical gynecological interventions.
