Purulent salpingitis: treatment

Fundamental are the following tactical principles: for any form of purulent inflammation, treatment can only be complex, conservative-surgical, consisting of:

• preoperative preparation;
• timely and adequate volume of surgical intervention;
• intensive postoperative treatment.

Preoperative preparation in patients with purulent salpingitis should be aimed at arresting acute manifestations of inflammation and suppression of the aggression of the microbial pathogen, therefore drug therapy for purulent salpingitis is a basic treatment measure and includes several components.

1. With the appointment of antibiotic therapy in everyday practice, we focus on the clinical course of infection. Neisseria gonorrhoeae, Chlamydia trachomatis, aerobic and facultative anaerobic bacteria should be covered by the spectrum of antibacterial therapy.

It is recommended to use the following drugs or combinations that affect the main pathogens with mandatory intraoperative (during laparoscopy) intravenous administration and continuation of antibiotic therapy in the postoperative period for 5 days.

• Combinations of penicillins with beta-lactamase inhibitors, for example, augmentin, which is a combination of amoxicillin and clavulanic acid. A single dose of the drug - 1.2 g IV, a daily dose of 4.8 g, a course dose of 24 g with intraoperative (with laparoscopy) intravenous injection of 1.2 g of the drug.
• Second-generation cephalosporins in combination with nitro-imidazoles, for example, cefuroxime + clion (metronidazole): a single dose of cefuroxime - 1.5 grams, daily - 4.5, exchange rate - 22.5 g; clion (metronidazole), respectively, 0.5; 1.5 and 4.5 g with intraoperative intravenous administration of 1.5 g of cefuroxime and 0.5 g of the clion (metronidazole).
• Fluoroquinolones, for example, ciprofloxacin in a single dose of 0.2 g iv in calylic, daily - 0.4 grams, course - 2.4 g with intraoperative intravenous injection of 0.2 g ciprofloxacin.

At the end of antibiotic therapy, all patients should make correction of the biocenosis with therapeutic doses of probiotics: lactobacterin or acylactone (10 doses 3 times) in combination with stimulants of normal intestinal microflora growth (for example, hilak forte 40-60 drops 3 times a day) and enzymes festal, mezim forte) in usual dosages.

2. Infusion therapy in the volume of 1000 - 1500 ml of liquid per day, the duration of therapy is individual (average 3-5 days). It includes:

• crystalloids - 5 and 10% solutions of glucose and substitutes that help to restore energy resources, as well as electrolyte exchange correctors - isotonic sodium chloride solution, Ringer-Locke solution, lactasol, yonostearil;
• plasmo-replacing colloids - rheopolyglucin, hemodez, gelatin, and also the ethylated 6% starch solution of HAES-STERIL-6 in a volume of 500 ml / day;
• protein preparations - freshly frozen plasma; 5,10 and 20% solutions of albumin.

3. The appointment of desensitizing and antihistamines in a daily dose, pathogenetic in the phase of acute inflammation, is shown.
4. The use of non-steroidal anti-inflammatory drugs with anti-inflammatory, analgesic and anti-aggregation effect is pathogenetically substantiated. The drugs are prescribed after the abolition of antibiotics. Diclofenac (voltaren, orthophen) is recommended for 3 ml IM every day or every other day (for a course of 5 injections).

Against conservative treatment in the first 2-3 days, it is necessary to evacuate purulent exudate (surgical component of treatment).

The method of "small" surgical intervention can be different and depends on a number of factors: the severity of the patient's condition, the presence of complications of the purulent process and the technical equipment of this hospital. The most simple method of removal of a purulent secretion is a puncture of the uterine rectal cavity through the posterior vaginal vault.

However, the most effective method of surgical treatment of purulent salpingitis at the present stage should be considered laparoscopy, which is shown to all patients with purulent salpingitis and certain forms of complicated inflammation (pyosalpinx, pyovar and purulent tubo-vascular formation) with disease duration not more than 2-3 weeks.

The use of laparoscopy is mandatory in young, especially nulliparous patients.

Contraindications are the presence of complicated forms of purulent process (pyovar, pyosalpinx, purulent tuboovarial formation) with a prescription period of more than 3 weeks.

In the complicated course of the purulent inflammatory process of the peritoneum of the small pelvis, the walls of the adjacent intestinal loops and the omentum, being welded together, form a "conglomerate" that closes the entrance to the small pelvis and access to the affected appendages. That is why the possibility of laparoscopic treatment for complicated forms of diseases, which is widely recommended recently, seems to us not only problematic, but also contraindicated.

Problems in laparoscopy, even in front of a highly qualified surgeon, in most cases determine not only the low therapeutic value, but also the insufficient diagnostic value of this method, which, in addition to establishing the fact of severe purulent inflammation, does not bear additional information; while attempts to perform endoscopic intervention in conditions of a purulent-infiltrative process can lead to life-threatening complications, in particular damage to adjacent organs.

[1], [2], [3], [4], [5]