Acute inflammatory diseases of the uterus appendages and acute appendicitis in women of reproductive age: principle of multidisciplinary approach in diagnosis and treatment

Abstract

Introduction. Acute inflammatory diseases of the uterus appendages (AIDUA) constitute the essential fraction in general structure of pathology of internal sexual organs in women and there is one of factors their barrenness and ectopic pregnancy. In the same time an acute appendicitis (АA) is dominant pathology in urgent abdominal surgery. Clinical trajectories these diseases in women of childbearing age quite often intersect in term «acute abdomen». Aim of research. To determine a diagnosticmedical approaches to these diseases as adjacent pathology in urgent surgery and gynecology on the basis of multidisciplinary principle. Materials and methods. The retrospective analysis of 1786 statistic cards of the dropped out sick women from the hospital with diagnosis AIDUA was realized. Helping prospective researches were included 128 patients of childbearing age, including 98 women with AIDUA and 30 patients on AA. For clarification of etiologic factor of AIDUA were held bacteriological investigations with aerobic (traditional method) and anaerobic (using transport mediums and boxes-anaerostats of firm BioMerieux, France) by cultivation of material, determination of type of bacteria and their sensitivity to antibiotics. Results of research and their discussion. Is established, that AIDUA constituted dominant fraction in structure of urgent gynecological pathologies (65%) with significant preponderance over acute inflammatory disease of uterus (4,9%), acute parametritis (1,3%) and contaminated cyst of ovary (2,8%). Ectopic tubal pregnancy apoplexy of ovary,complicated by internal bleeding, were observed in 2,7 times less often (in accordance in 12,0% and 12,2% cases). The results of bacteriological investigations showed, that spectrum of aerobic bacteria, submitted mainly by conditionally – pathogenic activators – Enterococcus spp. (18,6%), Enterobacter aerogenes (15,7%), Klebsiella oxytoca (14,3%), Pseudomonas aerogenosa (12,8%), among anaerobic nonclostridial bacteria more often were revealed Bacteroides fragilis (26%), Bactericides urealiticus (16,6%), Prevotella livia (14,2%), moreover as in monoculture, as in associations. The highest level of antibiotic sensitivity the aerobs manifested to imipenems (98%), cephalosporin’s (83%), fluoroquinolones (79%), and anaerobes – to protected penicillin’s, cephalosporin’s, clindamycin and imipinem (from 84% to 91%). Theproposed stepped algorithm of differential diagnosis with determination of value of clinical, laboratory – biochemical, ultrasonic and instrumental methods. All patients on AA were operated helping video laparoscopic machinery (73%) or traditionally (24%). 53 hospitalized patients with AIDUA (52%) were operated with performing of different for technique and volume of surgical interventions. Conclusions. AIDUA constitutea 65% in structure of urgent pathology of internal genitals in women of reproductive age. Etiologic factor submitted by wide spectrum of conditionally – pathogenic aerobic and anaerobic bacteria, mainly with gram – negative sign, as in isolated species, as in the form of associations. Clinical signs of AIDUA quite often intersect with symptoms of AA, in connection with this require multidisciplinary diagnostic – medical approach with the participation of doctors surgeon, gynecologist, doctor of USG – diagnostician, bacteriologist and clinical pharmacist on base of understanding of characteristic of etiological factor, peculiarities of antibiotic therapy and surgical video laparoscopic or traditional treatment.