home Audience 1 Fistula on the suture after cesarean section. Ligature fistula after surgical childbirth How to treat fistulas after surgery

Fistula on the suture after cesarean section. Ligature fistula after surgical childbirth How to treat fistulas after surgery

Fistula - what is it? You will find the answer to this question in the materials of the presented article. In addition, we will tell you about why this pathological condition occurs, as well as what symptoms it is accompanied by and how you can get rid of it.

General information

Fistula - what is this deviation? In medical practice, such a pathological phenomenon is often called a fistula. This word is derived from the Latin “fistula” and literally means “tube”. In other words, a fistula is a kind of canal that connects a tumor or abscess with the surface or two cavities (two organs) with each other.

Appearance

Fistula - what is this pathological phenomenon, what does it look like? As a rule, such a fistula looks like a rather narrow channel, which is lined with an epithelial layer and is accompanied by characteristic discharge.

Main reasons

Why does a fistula develop? The reasons for this deviation include the following:

After any inflammation stops, the pus usually comes out. Moreover, the channel through which it flows subsequently heals painlessly. However, in some cases (for example, if the inflammatory process has not been completely eliminated), deep in the tissue there continues to be a cavity with an infection (sometimes even with a dead area of bone), and therefore the “tube” does not grow together, but forms a purulent fistula.
Fistulas can arise from the roots of the tooth (with chronic periodontitis), passing through the gums and jaw.
If fragments of bullets and bones were not removed in time after the blind, then suppuration also forms next to them, which leads to the development of fistulas.
This deviation often occurs after surgical operations when sutures suppurate near ligatures (that is, threads used to ligate internal tissues, blood vessels, etc.). In this case, a ligature fistula occurs.

Types of fistulas by location

Before starting treatment for such a deviation, its type should be determined. This is not difficult to do, since this classification depends, first of all, on the location:

Gastric fistula. This pathology most often occurs after surgical operations (for example, after resection of the main digestive organ).
Rectal fistula.
Anorectal fistula. This deviation is characterized by a pathological canal coming from the anus (or rectum) to the skin.
Fistula pararectal. It goes outward from the anal crypt to the skin.
Rectovaginal fistula. With this disease, the rectovaginal septum is damaged.
Duodenal, or so-called intestinal fistulas. This is the external canal coming from the duodenum.
Bronchial fistula. Such a deviation is accompanied by a pathological connection between the bronchial lumen and the pleural cavity.

Types of fistulas due to their appearance

Absolutely any fistula (photos of these deviations are presented in this article) can be classified as follows:

Purchased. In other words, this phenomenon occurs as a result of suppuration (for example, a tooth fistula due to serious diseases such as osteomyelitis or tuberculosis.
Congenital. In this case, fistulas arise from developmental defects (at the navel, neck, etc.)
Created artificially. Such deviations form after surgery (for example, ligature fistula).

Types of fistulas based on contact with the environment

In this case, such a pathological phenomenon may be:

External, that is, going directly to the skin (for example, rectal fistula).
Internal, that is, not communicating with the external environment in any way, but connecting only adjacent cavities (for example, bronchoesophageal fistula).

Types of fistulas according to the nature of the secretion that is released from them

Such fistulas include:

purulent;
mucous membranes;
gall;
urinary;
feces, etc.

Main symptoms of the disease

The clinical picture of such a pathology depends, first of all, on the location of the fistulas and the cause of their appearance.

Thus, the main symptom of this disease (external) is a hole in the skin from which fluid is released. By the way, the appearance of a fistula can be preceded by either trauma to this area, or inflammation of nearby tissues and organs, or surgery.

As for internal fistulas, most often they appear as a result of complications of chronic or acute diseases. For example, gallstones are often formed due to obstruction of the ducts by a stone. In this case, the symptoms of the deviation depend on the amount of bile that is released into the abdominal cavity. Thus, the patient may experience severe pain and pronounced digestive tract disorders.

Bronchoesophageal fistulas are often complicated by food entering the tracheobronchial tree. It is this fact that leads to the development of aspiration pneumonia or bronchitis with corresponding symptoms.

Rectal fistula can be identified by the following symptoms:

The presence of a barely noticeable hole in the anus (on the skin). In this case, the patient may experience copious discharge of pus, and therefore he is forced to constantly wear a pad and regularly take a shower.
Aching pain in the anus. As a rule, such sensations are most intense during bowel movements, and then they noticeably subside.

A fistula on the gum is determined by such signs as:

severe tooth mobility;
tooth pain that gets worse when touched;
purulent discharge.

Diagnostic methods

If you observe at least one of the above symptoms, you need to immediately consult a doctor to make a correct diagnosis. It should be noted that specialists do not encounter any particular difficulties in diagnosing such a deviation. After all, it is based on collecting anamnesis, studying the characteristic complaints of patients, the type of fistula, analyzing the composition and amount of fluid released, as well as changing the functioning of the affected organs.

To clarify the direction and length of the fistula canal, as well as its direct connection with the lesion, probing and radiography are often used together with the introduction of a contrast agent into the passage.

By the way, you can clarify the diagnosis of “gastric fistula” with the help of tests for the presence of hydrochloric acid. If it is present in the canal, then this indicates the gastric location of the fistula. But urinary fistula is characterized by the presence of uric acid salts.

It should be especially noted that external fistulas are much easier to diagnose than internal ones. After all, they have a characteristic hole that is visible to a specialist with the naked eye. As for internal fistulas, they should be identified not only by the patient’s existing symptoms and complaints, but also using diagnostic methods such as ultrasound, radiography and endoscopy.

Fistula: treatment with official medicine

Therapy for patients with external fistulas is based on:

local treatment;
general therapeutic;
operational.

Local therapy refers to the treatment of the resulting wound, as well as the protection of surrounding tissues from the effects of fluid that is released from the canal. For example, if the fistula is on the leg, abdomen, etc., then the purulent area is treated with various means (ointments, pastes and powders). They are applied at the external opening of the canal, thereby preventing the skin from coming into contact with pus, mucus, etc.

In addition, chemical agents can be used that prevent irritation of external tissues by neutralizing secretions from the fistula passage. For this, it is recommended to use enzymes (for example, “Gordox”, “Kontrikal”, etc.).

Mechanical methods of protecting the skin are aimed, first of all, at reducing or completely stopping discharge from the canal using special devices.

For the general treatment of purulent and other fistulas, they are constantly washed with an antiseptic solution.

Tubular granulating passages quite often close on their own after eliminating the causes of their occurrence (for example, removal of bone sequestration, ligature, etc.). But labiform fistulas never go away on their own. To treat such deviations, only surgical intervention is used to excise them, suturing the external holes, or resection of the affected organ.

It should also be noted that in some cases, surgeons create fistulas artificially specifically so that the patient can eat, or in order to remove accumulated secretions from any internal organ. These channels can be either permanent or temporary. After the patient's condition improves, the temporary canals are closed surgically.

In addition to external ones, internal fistulas (interorgan) are also created artificially. As a rule, they are imposed either for a long time or for life.

Treatment of fistula with folk remedies

Of course, treatment of such a deviation requires mandatory consultation with an experienced doctor. Indeed, if treated untimely and incorrectly, a fistula can lead to serious complications that can endanger a person’s life.

But, despite this likelihood, adherents of alternative medicine still use numerous folk methods to close the resulting fistulas. Let's look at some of them in more detail.

Treatment of ligature fistula with aloe

To prepare the medicine, you need to take 10-12 fleshy arrows from the presented plant, and then wash them in warm boiled water. Next, the aloe needs to be finely chopped and placed in a liter jar. Pour 300 g of any honey into the container, cover loosely and place in a dark place for 7-10 days. In this case, after 4-5 days it is advisable to mix the mass well. Finally, the tincture must be strained several times and taken a dessert spoon three times a day.

Ointment for external fistulas

This ointment is good for healing and treating vaginal fistulas and for this we need water pepper grass, oak bark, lard and flax flowers. All imposed plants must be chopped, and then placed in some container and immediately poured with melted lard. In this case, the ratio of fat and herbs should be one to two.

After these steps, you need to place the filled dish in the oven and turn on low heat. It is advisable to heat the ointment for at least 7-11 hours. Finally, the medicine must be cooled at room temperature. The method of treatment with this ointment is quite simple. To do this, you need to make a cotton swab, generously lubricate it with the product, and then apply it to the fistula opening. It is advisable to change dressings every five hours.

Decoctions for external fistulas

Infusions and decoctions of medicinal chamomile are used only externally - for washing holes. To prepare them, you need to take 1 large spoon of dried flowers, brew them with one glass of boiling water, and then leave for 60 minutes and filter.

Also, decoctions made from calendula are used to wash fistulas and create compresses.

Prevention

Now you know how to treat a fistula, what it is, and why it occurs. Prevention of acquired channels should include the prevention of infectious diseases. In addition, it is necessary to strictly observe the rules of asepsis during surgical interventions.

As for the prevention of congenital fistulas, this is impossible, since the disease occurs in the first trimester of pregnancy.

Almost every surgical intervention ends with the closure of the wound by placing surgical sutures on it, the only exceptions being operations performed on purulent wounds, in which, on the contrary, it is necessary to create conditions for the unhindered outflow of the purulent contents of the wound and reducing inflammation around the wound.

Surgical sutures are of both natural and synthetic origin. At the same time, they are divided into those that are absorbed in the body after some time and those that are not absorbed.

There are cases when a pronounced serous inflammatory process appears at the site of sutures, which subsequently begins to secrete pus. This behavior is a reliable sign that after the operation a fistula has formed and the process of its rejection has begun. It is worth noting that the appearance of a fistula is an abnormal reaction of the body, so additional treatment is required.

Causes of ligature fistula after surgery

Rejection by the body due to an allergy to the material from which the surgical thread is made.

Infection attached to the postoperative wound (failure to keep the wound clean, insufficient antisepsis during the operation).

In addition, the following factors may influence the appearance of a ligature fistula after surgery:

Metabolic disorders in the body (metabolic syndrome, obesity, diabetes).

Lack of minerals and vitamins.

The presence of cancer that depletes the body (protein depletion).

Localization and type of surgical intervention (ligature fistula after cesarean section or fistula after surgery for paraproctitis).

A hospital infection that occurs in all hospitals and is represented by saprophytic microorganisms (streptococcus, staphylococcus), which are normally present on the skin of a healthy person.

The presence of a specific chronic infection in the body (syphilis, tuberculosis).

High immune reactivity of the body (young people full of energy).

General condition and age of the patient.

It is worth noting that ligature fistulas:

They appear in any part of the body and in any layers of the surgical wound (internal organ, muscle, fascia, skin).

Do not depend on time (can occur in a year, month, week).

They occur regardless of the material from which the surgical thread is made.

They have various clinical manifestations (rejection of sutures with suppuration of the wound and without its healing, or rejection with subsequent healing).

Manifestations

In the first days, compaction, slight swelling, pain, redness, and an increase in local temperature appear in the projection of the wound.

After a week, a characteristic serous fluid begins to emerge from under the surgical sutures, and especially when pressing on them, which is subsequently replaced by pus.

At the same time, there is an increase in general temperature, which increases to subfebrile levels.

Sometimes the ligature fistula closes on its own, but after a while it opens again.

Complete cure is possible only after surgery, which is aimed at eliminating the causes of inflammation.

Complications arising from ligature fistula

An abscess is a cavity filled with pus.

Cellulitis is the spread of purulent formations under the skin through fatty tissue.

Eventration - due to purulent melting through the surgical wound, prolapse of internal organs may occur.

Sepsis is a breakthrough of purulent contents into the cavity of the skull, chest, and abdomen.

Toxic-resorbative fever is a severe form of the body’s temperature reaction to the presence of a purulent focus in it.

Diagnostics

A ligature fistula can be identified by visiting the dressing room during a clinical examination of the postoperative wound. Also, if you suspect the development of a ligature fistula, you should undergo an ultrasound examination of the wound for the presence of an abscess or purulent leaks.

If diagnosis is difficult due to the deep location of the ligature fistula, fistulography can be used. The essence of this method is to inject a contrast agent into the fistula tract, after which an X-ray examination is performed. The image will clearly show the location of the fistula tract.

Treatment

Before proceeding with the treatment of a ligature fistula, it should be noted that without surgical elimination of the source of inflammation and its consequences, a cure cannot occur, and the prolonged existence of a fistula will only aggravate the course of the disease. In the presence of a ligature fistula, complex treatment of the pathology is necessary with the mandatory use of:

the enzymes chymotrypsin and trypsin, which dissolve necrotic tissue;

antibiotics with a wide spectrum of action - ampicillin, levofloxacin, norfloxacin, ceftriaxone;

local antiseptics. Fine powders - gentaxan, baneocin, tyrosur. Water-soluble ointments - levosin, trimistin, levomekol.

Such enzymes and antiseptics are introduced directly into the fistula tract itself, as well as into the tissues surrounding it, given that the activity of such drugs and substances lasts no more than 4 hours, they are administered several times a day.

If there is abundant discharge of purulent masses from the fistula, it is strictly forbidden to use fatty ointments (synthomycin, Vishnevsky), since they clog the fistula canal and disrupt the process of outflow of pus.

In the inflammation phase, active use of physiotherapeutic procedures (UHF therapy, wound quartz treatment) is allowed. Such procedures help improve microcirculation of lymph and blood, reducing the spread of infection and swelling, and also have a detrimental effect on pathological microorganisms in the wound. The use of such measures makes it possible to achieve stable remission, but does not guarantee complete recovery.

If a fistula does not close, getting rid of it can only be guaranteed through surgery. This option for treating a ligature fistula is a generally accepted standard, because eliminating the cause of constant suppuration can only be achieved through surgical treatment of a postoperative wound with a complication that has arisen in it.

Sequence of actions during surgery to eliminate a ligature fistula

triple treatment of the surgical area with antiseptics (usually an alcohol solution of iodine);

introduction of anesthetic substances into the projection of the surgical wound and under the wound (0.5-5% novocaine solution, 2% lidocaine solution);

injection of dye (hydrogen peroxide and brilliant green) into the fistula tract to speed up the search;

dissection of the wound and complete removal of suture material;

detection of the cause of fistula formation and its removal together with surrounding tissues;

stopping bleeding using a 3% solution of hydrogen peroxide or an electrocoagulator; suturing the vessel is unacceptable, as this may cause a new fistula;

washing the wound with an antiseptic after stopping the bleeding. The most commonly used antiseptics are decasan, 70% alcohol, and chlorhexidine. After this, the wound is closed with a secondary suture, while organizing active drainage of the area.

The postoperative period involves periodic washing of the drainage and dressing. If there is no purulent discharge, the drainage system is removed. For multiple purulent leaks and phlegmon, the patient is prescribed:

ointments that stimulate the healing process (troxevasin, methyluracil);

anti-inflammatory drugs (NSAIDs - nimesil, diclofenac, dicloberl);

antibiotics;

You can also simultaneously use phytotherapeutic preparations that are rich in vitamin E (aloe, sea buckthorn oil).

It is worth noting that the most effective for ligature fistula is the classical operation, which involves a wide dissection to perform an adequate revision. Any minimally invasive methods (using ultrasound) for such pathology are of low effectiveness.

It is important to remember that self-medication when a ligature fistula forms on a postoperative scar is unacceptable, since in the end, surgical intervention will still be required to treat the fistula, but this will waste time, which may be enough for the development of complications that are life-threatening.

Prevention after surgery and prognosis

Preventing the appearance of a ligature fistula is, in principle, impossible, because infection can penetrate the suture even under the most aseptic conditions, and it is generally impossible to prevent a rejection reaction.

In most cases, treatment of a ligature fistula with surgery is quite effective, but there are cases when the patient’s body constantly rejects any type of surgical sutures, even after a large number of repeated operations.

Any independent treatment of a ligature fistula has an unfavorable prognosis.

The article will tell you how to get rid of a postoperative fistula.

What is a fistula and ligature fistula after surgery on a suture or scar: causes, signs, photos

Fistulas appear on the body as a consequence of pathological interventions, for example, surgery. Their appearance is quite justified, because they arise where liquid secretions from the affected organs or tissues need to come out. The discharge mainly consists of pus, bile and urine. The fistula becomes an obstacle to wound healing or recovery.

The nature of fistulas can be different:

Congenital fistulas (occur when there is a developmental defect)
Acquired fistulas (occur when there is injury or damage to internal organs and tissues).
Artificial fistulas (occur when an abscess ruptures or when any internal organ is damaged).

The locations of fistulas are also different:

Internal fistulas
External fistulas
Single fistulas
Multiple fistulas

You should similarly learn about each type of fistula:

Purulent fistula. It appears when the drainage of pus at the site of injury is obstructed. This type is dangerous to health, since its healing is quite difficult due to the ongoing inflammatory process.
Urinary fistula. Appear in the ureters and in places of the urinary organs. Most often occur due to injury. Sometimes they are created specifically to remove urine.
Gastric fistula. They are created artificially to feed the patient. Such a fistula is a necessity in case of a serious illness.
A fistula formed on the intestine (small). Consequences of a complex operation or injury. With proper treatment, it heals on its own.
Fistula formed on the intestines (thick). Appears artificially or as a consequence of injury. It is difficult to heal, as it is “hampered” by constant feces.
Biliary fistula. Appears after surgery. Such a fistula is a consequence of bile entering the tissue and metabolic disorders. Requires quick and effective treatment.
Salivary fistula. Occurs in any area of the mouth and is a consequence of the inflammatory process.

How to diagnose a fistula:

A fistula can be diagnosed using an external or internal examination.
It is common for a fistula to form a channel from which discharge oozes.
The nature and intensity of the discharge (and therefore the degree of damage) can be determined by inserting a probe.
A special dye will help determine the degree of damage to an internal organ by the fistula.

Fistula on the seam

Ligature fistula

Purulent fistula on a postoperative suture: what antibiotics to treat?

A fistula is a connecting channel present in the tissues and cavities of the body. It connects cavities and hollow organs to each other, as well as to the external environment. Its surface consists of epithelium and granulation tissue, through which purulent discharge comes out.

Why does a fistula appear after surgery:

It is possible that during the surgical procedure, there was an infection in the body that was never eliminated.
Another option is that there was an inflammatory process in the patient’s body.
In the case of a “blind” gunshot wound, after which surgical intervention was performed. In this case, it is important to remove all fragments from the body so that they are not perceived as a “foreign body” and do not provoke the process of decay.
If the body does not accept the surgical threads with which the body is sutured after surgery. In such situations, the scars begin to fester.
Violation of sterility requirements. This is the most common cause of a fistula after surgery. For example, non-sterile material and instruments were used during work. In this case, the compaction appears in the very place of the scar.

A fistula after surgery is, first of all, an inflammatory process. That is why its characteristic signs are quite easy to recognize:

Lump around the scar
Scar redness
Scar burning
Itching of the scar and around the stitch
The appearance of tubercles in the damaged area
Increased body temperature
Purulent discharge at the scar site
The site of injury may be swollen
The scar may hurt when moving or applying pressure.

IMPORTANT: If a fistula is detected, treatment should be started immediately, which will be aimed at disinfecting the wound, eliminating the inflammatory process and accelerating the healing process.

Fistula after surgery

Purulent fistula on a postoperative suture: what medications and ointments should be used for treatment?

Each fistula is treated depending on its location and nature of acquisition, as well as focusing on whether it is external or internal. After discovering a fistula, you should definitely consult a doctor about its treatment. A fistula must be treated, otherwise it can lead to serious complications or death for a person.

IMPORTANT: Treatment of a fistula, depending on its complexity and complexity, can be done using traditional and folk remedies.

What can be used to treat a fistula:

Penicillin-based antibiotics are effective in treating fistula. It is important to check your reaction to this substance so as not to worsen the condition.
Often a doctor prescribes the antibiotic “aspergin”. The good thing about this medicine is that it can effectively kill pathological microorganisms that cause inflammation.
The damaged area must be treated local disinfectants, for example, a solution of brilliant green.
The use of non-steroidal painkillers is effective, for example, Ibuprofen. The medicine will not only have an anti-inflammatory effect, but also eliminate pain.

How and with what should a fistula be treated?

Folk remedies for the treatment of postoperative fistula

Traditional medicine can also help in the treatment of postoperative fistula, or rather, contribute to its rapid healing. To do this, you can use the following recipes:

Aloe juice is very effective, which is known for its anti-inflammatory and healing properties. To treat a fistula, you can simply treat the wounds with arrow juice several times a day, or you can prepare a tincture.
Prepare an ointment to treat the fistula. This ointment is useful to use when you have a fistula in the rectum or vagina. It is prepared from oak bark (effectively eliminates inflammation), water pepper herb and toadflax flowers. The binder in the recipe can be lard (rendered). It is important to maintain the exact ratio of ingredients and not exceed the concentration of fat and herbs 1:1.
Rinsing the fistula opening with chamomile decoction is very useful., known for its powerful anti-inflammatory properties. Brewing chamomile is very simple, 1 tbsp is enough. flowers and 1 cup boiling water. Infusion time is 15-20 minutes. Using the same principle you can brew calendula flowers.

Purulent and ligature fistula of a postoperative scar after childbirth, cesarean section, appendicitis: excision surgery

The causes of postoperative fistula in the case of surgical intervention (as well as childbirth, excision, caesarean section) may be insufficiently disinfected surgeon's instruments or poor-quality materials.

During and after the operation, it is important to follow all the rules for caring for the injury site, using antiseptic agents. The nature of the pathogenic microbe that has entered the body, as well as the human immune system that resists it, is also important. There are no exact dates for a fistula and it can appear at any time after surgery, either after a few days or after several months.

Pay attention to your scar after surgery or “cesarean”. If the seam turns red, itches and hurts, these are clear signs of a fistula in the first stages, the next sign is ichor and pus. A suture after a caesarean section can fester only when it is not treated sufficiently. To avoid serious inflammation, it is important to use all the forces and means to eliminate the fistula.

Video: “Suture after caesarean section: care, what does it look like?”

Every operation, and delivery by cesarean section is no exception, ends with a suture. The purpose of processing the incision is to stop bleeding and prevent massive blood loss. For this purpose, a suture material such as a ligature is used, which normally does not cause any complications to patients.

If the body's reaction to the ligature is unpredictable, a focus of inflammation forms around the threads, an abscess is formed with purulent melting of the tissue. Generally accepted requirements for the antiseptic properties of surgical material and the surgical field require careful treatment of the incision before suturing. If pathogenic bacteria enter the wound, an inflammatory process will inevitably develop, complicated by the formation of a fistula.

Around the ligature that tightens the edges of the incision, the tissue compacts, forming a granuloma. It consists of collagen fibers, suture material, and fibroblasts. The introduction of pathogenic bacteria into this tissue causes suppuration. The pus finds its way out, and a through hole, or fistula, is formed. There may be a single ligature fistula, or pus breaks out in several areas of the surgical suture.

The time for the formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula may spontaneously close for a while, but final recovery does not occur until the source of suppuration is eliminated.

Reasons for appearance

For the occurrence of a fistula after a cesarean section, there must be predisposing factors.

Frequent reasons for the formation of a ligature fistula:

Infected suture material;

Infection of the surgical field;

Low quality ligature;

Violation of antiseptic rules during and after surgery;

Improper processing of the surgical suture;

The stress associated with pregnancy and childbirth, a stress factor, weakens a woman’s immunity. This circumstance significantly increases the risk of an inflammatory process, rejection of foreign material (ligature), and an allergic reaction to it.

The danger of education

If a fistula forms on the suture left after a cesarean section, it is necessary to immediately take effective measures, because the risk of secondary infection of the body increases. Intense purulent discharge leads to irritation and maceration of the skin, the appearance of dermatitis.

Further development of the inflammatory process leads to intoxication of the body with products of tissue breakdown and the activity of pathogenic bacteria. When a fistula ruptures, there is a high probability of infection entering the bloodstream, which leads to the development of sepsis. This complication can lead to disability and even death.

Complications of ligature fistula:

Toxic-resorptive fever is the body’s reaction to the formation of a purulent focus and the accompanying high temperature, which negatively affects the functioning of most organs;

The appearance of phlegmon is the spread of inflammation in the subcutaneous fatty tissue;

Prolapse of abdominal organs from a molten wound.

Complications can be prevented only by timely diagnosis of a ligature fistula.

Symptoms

Women who have undergone a cesarean section should know the main symptoms of the pathology, because a ligature fistula can form several months after the operation.

Higher skin temperature around the suture compared to the rest of the body;

The separation of pus and ichor from the suture, sometimes it can be minimal, giving the impression that the wound is getting a little wet.

When a ligature fistula appears, the body temperature always rises. At the early stage of the onset of complications, temperature values may be close to normal, but still increase. The more the inflammatory process develops, the more pronounced the hyperthermia.

Diagnostics

Not all women can independently detect the onset of the inflammatory process in time. Typically, the patient consults a doctor when the wound infection has gone too far. If the wound after a cesarean section is regularly examined by a specialist, it is possible to detect the pathological process at the earliest stages and prevent complications.

Palpation of granular tissues;

Studying the patient’s medical history and complaints;

Probing the ligature fistula to determine the parameters of the defect;

Ultrasound with contrast;

X-ray examination with the introduction of a contrast agent.

Treatment

It is strictly unacceptable to self-medicate a ligature fistula after a cesarean section at home or wait until the surgical thread comes out on its own. Only in a surgical hospital setting is it possible to prevent the spread of infection, open the suppuration and remove the fistula.

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Surgical treatment

There are two tactics for surgical treatment of a ligature fistula: the doctor removes the thread that caused the inflammation, or excises the entire fistula, which is preferable in many cases. The thread is removed blindly through a small incision in the seam area. The suppuration is cleared of ichor and pus and washed with an antiseptic solution. If it is possible to completely get rid of the cause of inflammation, the fistula is completely healed. If relapses occur, the operation is repeated.

A wide incision is not made because there is a risk of cellulitis forming and infection spreading to healthy tissue. The surgeon may decide not to make an incision, but to remove the ligature from the fistula canal with a special tool. After the manipulation, the wound is treated with antiseptic drugs, and the bandage is regularly changed.

In modern clinics, the procedure is carried out under the control of ultrasound scanning, which makes it possible to accurately determine the location of the ligature that caused the inflammation.

A radical way to get rid of the source of inflammation is single-block excision of the fistula. In this case, both the fistula canal and the suture material that caused the pathology are removed. The operation is performed under local anesthesia, with careful adherence to antiseptic rules. After removal of the fistula, the wound is sutured, its condition is monitored for 5 days. After the fistula excision site has healed, the sutures are removed from the wound.

Conservative treatment methods

In cases where the inflammatory process has not yet gone too far, drug therapy can be used. It consists of treating the inflamed area with antibactericidal and antiseptic solutions. The purpose of the treatment is to destroy pathogenic bacteria over the entire area of the wound. Treatments are carried out frequently to effectively remove pus and disinfect the suture area.

If it is possible to stop the inflammation in this way, the ligature fistula may heal spontaneously. To support immunity, immunostimulants and vitamin complexes are prescribed. A course of antibiotics will help prevent the infection from spreading. When the body's defenses increase, the focus of inflammation will decrease or disappear completely.

With this method of treatment, there is always a risk of relapse, since the suture material remains in the wound. If the appearance of a ligature fistula was provoked by a surgical thread, the process may be repeated.

Prevention

Even with the strictest adherence to antiseptic rules during cesarean section, there remains a risk of ligature fistula. It is impossible to predict in advance whether a woman will experience rejection of the suture material or not. However, preventative measures will help prevent complications from occurring.

Rational management of cesarean section;

Compliance with antiseptic rules;

Careful preparation of the surgical field;

Use of modern surgical materials.

To prevent the development of inflammation of the suture after a cesarean section, you need to carefully monitor its condition for several months after the operation.

A fistula is a channel that connects a body cavity or hollow organs to the external environment or to each other. A fistula is also called a fistula. Most often it is represented by a narrow tubule, which is covered from the inside with epithelium or young connective tissue. Fistulas can form against the background of various pathological processes occurring in the body, as well.

A fistula on the gum of a tooth is a pathological formation represented by a small passage through the gum to the lesion. Most often, the fistula comes from the root of the diseased tooth. It drains serous or purulent exudate from the source of inflammation. You can see the fistula at the projection site of the tooth, in its upper part. It looks like a sore spot.

A perirectal fistula occurs as a consequence of metabolic disorders in the tissue around the rectal ampulla. Most often, these are the consequences of paraproctitis, or proctitis, the symptom of which is a fiber abscess. Its main manifestations are purulent or bloody discharge, pain, itching, and irritation of the epidermis of the anal area.

The information on the site is intended for informational purposes only and does not encourage self-treatment; consultation with a doctor is required!

Ligature fistula after surgery: what do you need to know about it?

Complications that arise after surgery, ligature fistulas, pose a danger to the patient because they become a source of infection and can cause severe intoxication of the body.

Causes of ligature fistula after surgery

Any surgical intervention ends with postoperative treatment, which consists of a suture performed with a ligature, a special surgical thread, absorbable or non-absorbable.

The use of non-absorbable, usually silk, threads assumes that they will remain permanently at the wound site, undergo an encapsulation process and will not cause any harm to the patient.

However, there are situations when various kinds of complications occur, causing the development of an inflammatory process in the area of the suture, ligature fistulas. This phenomenon is infectious-allergic in nature of rejection and rejection of material foreign to the body.

A ligature fistula may develop after surgery:

When the ligature itself is infected
If the rules of asepsis are not observed or violated during the operation
If the ligature becomes infected with the contents of the wound
In case of imperfect treatment of the postoperative area and infection in the suture area

The development of the inflammatory process is influenced by the state of the patient’s immune system; aggressiveness, infective ability of the microorganism that causes it; allergic reaction of the body.

The formation of ligature fistulas is characterized by:

Various localization in the postoperative area, in any tissue layer
Delayed temporary nature of manifestation, from several days, weeks, months, years after suture application
Varying degrees of severity of the inflammatory process - from a local area with rejection of the suture material and healing of the fistula to long-term non-healing inflamed areas along the entire length of the suture
Independence of the material from which the non-absorbable ligature is made (silk, nylon, lavsan)
Various consequences for the patient - from quickly healing and practically not causing concern to a constant source of infection that causes intoxication of the body, which can lead to disability for the patient

Postoperative complications in the form of ligature fistulas are inflammatory processes caused by infection in the areas of sutures.

A vaginal-rectal fistula is clearly presented in this video.

Symptoms and diagnosis

The formation of a ligature fistula is accompanied by certain events:

Formation of local compaction, granuloma, in the area of the surgical suture, hyperemic, often hot to the touch
With a deep location of the fistula, the granuloma cannot be felt during palpation
As a rule, the size of the inflamed area is limited.
The formation of compacted areas may be accompanied by painful sensations
The formation of a hole in a reddened, compacted area, a fistula canal, through which purulent contents are separated, abundant or slight
In some cases, in the opening of the fistula tract, you can notice the end of the ligature, larger or smaller in size
The fistula canal may close and open again after some time.
Complete closure of the fistula opening occurs after removal of the infected ligature

The formation of a ligature fistula can be accompanied by a significant increase in body temperature, up to 39 degrees

Detection of a fistula, as a rule, does not cause difficulties.

To confirm the diagnosis of “ligature fistula after surgery”, it is necessary to perform the following measures, which are carried out by a surgeon.

Diagnostics:

Examination of the patient, assessment of the inflamed area and fistula canal, palpation of the granuloma
Analysis of patient complaints, study of his medical history, data on surgical operations performed
Probing the fistula canal and assessing its depth
Carrying out various methods of studying the fistula canal using dyes, x-rays, and ultrasound analysis methods

You should consult a doctor as soon as possible if the listed symptoms appear, and do not make independent attempts to treat the wound or remove the ligature from the fistula canal.

Timely diagnosis of a ligature fistula will allow immediate treatment to begin.

Ligature fistula: treatment

Treatment of a fistula is mandatory in a medical institution by a qualified surgeon. Self-medication and treatment of the inflamed area in non-sterile conditions are fraught with additional infection and complication of the condition.

Waiting for the thread to come out and the pus to break through without medical intervention is also dangerous, as it can lead to the development of phlegmon and suppuration of neighboring areas.

Therapeutic measures can be carried out using both conservative methods and more radical surgical ones.

During conservative treatment, measures are taken to eliminate the infection in the inflamed area, resulting in the closure of the fistula opening.

To treat the fistula area, antiseptics, antibacterial drugs, and non-selective bactericidal solutions are used.

Treatment is accompanied by the prescription of antibiotics, anti-inflammatory drugs, immunomodulators, and vitamins.

Unfortunately, there are frequent cases of re-opening of the fistula if the ligature remains unremoved.

Surgical treatment methods are aimed at removing infected non-absorbable suture material from the fistula.

Removing it is carried out as follows:

In operating conditions, the surgeon cuts the tissue in the area of the fistula in order to release the pus
The wound is cleaned and washed
Steps are taken to blindly remove the suture material.
If successful, this will lead to the final closure of the fistula
If the attempt is unsuccessful, it will be repeated after a while until the thread is successfully removed
Expanding the dissection area is fraught with infection and its spread to neighboring areas
Sometimes attempts are made to remove the ligature using special surgical instruments without cutting the tissue, through the fistula canal
Both in case of successful removal of the thread and in case of failure, the wound is treated with antiseptic drugs; the wound is bandaged; treatment is carried out for the required period while monitoring the condition of the wound

Methods have been developed for removing threads using ultrasonic control methods. The advantages of such modern techniques are the directed actions of the surgeon and a more gentle procedure for the patient.

If there are several fistulas along the postoperative suture, an operation is performed to excise the affected area and remove the ligature.

A necessary condition for effective treatment of a ligature fistula is the patient's full awareness of the steps being taken and the treatment methods used.

Prevention

Preventive steps to prevent postoperative complications in the form of ligature fistulas are carried out and depend entirely on the surgeon.

Prevention measures:

Strict adherence to the principles of asepsis and antisepsis
Checking the suture material before using it - tightness of the packaging, expiration date, confirmation of sterility
Thorough preparation of the wound with antiseptic treatment before suturing
The use of modern suture materials at the final stage of surgery; if possible, avoid using non-absorbable silk threads

The implementation of preventive measures by the surgeon to prevent postoperative complications will reduce the percentage of inflammatory diseases in patients.

Awareness of patients about possible complications after surgery will allow them to promptly detect their symptoms if they appear and promptly seek medical help.

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How is a fistula that appears after surgery treated?

After surgery, a fistula can occur for many reasons. It usually appears after operations on cavity and tubular organs. The fistula may not heal for a long time, leading to damage to many parts of the body and, in some cases, to the formation of malignant tumors. The formation of a non-healing wound indicates that an inflammatory process is occurring in the body.

Causes of fistulas after surgery

If during surgery a foreign body enters the body, causing inflammation and infection, postoperative complications may begin. There are many reasons for this. One of them is a violation of the removal of purulent masses from the fistula canal. The occurrence of an inflammatory process may be associated with difficulty in the release of purulent masses due to the narrowness of the channel, the presence in the drainage fluid of products of the organ that has undergone surgical intervention. In addition, the reasons for the formation of non-healing postoperative wounds can be improper operation and infection in an open wound.

A foreign body that enters the human body begins to be rejected. As a result, the immune system weakens and the body ceases to resist infections. All this delays the recovery period after surgery and causes encapsulation - infection of the operated organ. In addition, a foreign body in the body causes suppuration, which serves as an additional factor interfering with the healing of the suture. Such cases include bullet wounds, closed fractures and other body injuries. Ligature fistulas occur when the body rejects the threads that hold the edges of the wound together.

The appearance of a fistula on the suture can occur both in the first days after surgery and many years later. This depends on the severity of the inflammatory process and the depth of the tissue incision. The fistula can be either external (extending to the surface and in contact with the external environment) or internal (the fistula channel extends into the organ cavity).

A postoperative fistula can be created artificially. It is introduced into the digestive system to provide artificial nutrition to the patient. An artificial rectal fistula is formed for the unimpeded removal of feces.

Fistulas in the human body can form due to various chronic or acute diseases that require urgent surgical intervention.

If a cyst or abscess occurs in the cavity of an organ, bone or muscle tissue (with the subsequent appearance of a fistula), doctors excise the suture again. If the inflammation is not eliminated, the infection becomes more severe and leads to the development of new fistulas.

Types of postoperative fistulas

A ligature fistula is formed after the application of non-absorbable threads and with further suppuration of the sutures. They exist until the surgical threads are completely removed and may not heal for quite a long time. A fistula resulting from tissue infection is a consequence of non-compliance with the rules of antiseptic treatment of the suture or subsequent divergence of the sutures.

Fistulas of the rectum or genitourinary system lead to a deterioration in the general condition of the body. The release of feces and urine to the outside is accompanied by an unpleasant odor, which causes a lot of inconvenience to a person. Bronchial fistulas are a complication of surgery to remove part of the lung. There are no more advanced methods for suturing the bronchi.

Treatment methods for postoperative fistulas

If there is a strong immune system and there is no infection of the operated tissues, the recovery period ends successfully. However, in some cases the suture may become inflamed. The resulting ligature fistula is treated surgically. When diagnosing ligature fistulas, doctors use methods to determine the location of the foreign body that caused inflammation and development of the fistula. These methods include double images, the four-point method and tangent planes. When the fistula is opened, the foreign body itself and purulent masses are removed through its canal.

If the treatment is successful, the inflammation is eliminated and the fistula resolves itself. This process can occur spontaneously in very rare cases. This usually takes a lot of time; the disease can become chronic and cause serious complications. The number of fistulas formed depends on the number of infected ligatures and the activity of pathogenic microorganisms. Depending on this, the frequency of the release of purulent masses from the fistula canal changes. Ligature fistula is treated both medically and surgically.

Conservative treatment is recommended when the number of fistulas and pus discharged from them is minimal. The essence of the treatment is the gradual removal of dead tissue that interferes with wound healing and removal of surgical sutures. In addition, the patient is recommended to take medications that strengthen the immune system. For faster and more effective treatment, it is necessary to take antibiotics and treat the affected area with antiseptics.

The seam is usually treated with hydrogen peroxide or furatsilin solution. This helps remove purulent discharge, protect the wound from infection and speed up its healing. During inpatient treatment, constant ultrasound monitoring is performed, which is considered the most gentle method of treatment.

Surgical intervention is prescribed for patients with a large number of fistulas and a fairly intense outflow of purulent masses. This method is also used when there is a foreign body in the body and there are serious postoperative complications. To prevent the occurrence of ligature fistulas after surgery, it is recommended not to use silk threads for suturing and to observe antiseptic measures.

Surgical treatment of such complications involves excision of the fistula canal, cauterization or curette removal of granular tissue throughout the canal. In addition, the surgeon removes the festering suture material.

If necessary, an operation is performed above the suture to remove it along with surgical threads and fistulas.

If one of the ligatures becomes inflamed, only part of the suture is excised and removed. After this, the sutures are reapplied.

If treatment for postoperative complications is not started in time, they can become chronic and lead to disability for the patient. Treatment of a ligature fistula should begin when its first symptoms appear.

Treatment of fistula with folk remedies

In the early stages of the disease, treatment with traditional methods can be quite effective. Treatment with a mixture of vodka and olive oil gives good results. The mixture must be used to treat affected areas. After performing this procedure, a cabbage leaf is applied to help draw out the pus. The course of treatment lasts several weeks, after which the fistula disappears.

Fistulas on the skin can be cured with a mixture of aloe juice and mumiyo. The mummy needs to be soaked in warm water, the resulting solution mixed with aloe juice. This medicine is used in the form of gauze compresses. Compresses with a decoction of St. John's wort also give good results. 2 tbsp. spoons of dry herb are poured into a glass of water and brought to a boil. After this, the broth is filtered and used for compresses. Fresh leaves of St. John's wort can also be used for treatment. They are placed on a film, which is applied to the affected area. The course of treatment lasts until the wound is completely healed.

Rectal fistula can also be cured using traditional methods. Mix a small amount of toadflax flowers, water pepper leaves and oak bark. The mixture should be cooked over low heat in an oven. Apply the prepared ointment to the affected areas using a cotton swab. The course of treatment lasts about 3 weeks. The same method can be used in the treatment of vaginal fistulas. This ointment can also be prepared using onions.

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Fistula after surgery: how to treat?

It often happens that an infection that progresses inside seeks a way out. This especially happens after surgery. Let's look at why this happens and how the resulting fistula is treated after surgery.

Fistula - what is it?

A fistula is a canal that connects body cavities or hollow organs to each other or to the external environment. It is lined with epithelium, and through it pus comes out, or the canal is lined with granulation tissue. If this does not happen, then a purulent fistula forms.

Such a process may be the result of some inflammatory process in the body or a consequence of surgery.

Types of fistulas

Depending on where the fistula is located, they are divided into:

The fistula can be complete or incomplete. A complete one has two holes and is treated faster, since it has a way out; an incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labiform or tubular. Labial can only be treated with surgery.

If we consider the process of formation, then a granulating fistula is one that is not yet fully formed, while a tubular one is already lined with epithelium and is fully formed.

What are the reasons for the appearance of a fistula after surgery?

There are several reasons for this phenomenon:

The source of infection has not been completely eliminated.
In case of chronic prolonged inflammatory process.
Like the consequences of a blind gunshot wound. Small particles in the body, fragments, are perceived by the body as a foreign body, and the process of putrefaction begins.
The body’s denial of the threads used in surgical operations, as a result, the sutures fester.

The last point is the most common reason why a fistula appears after surgery. There are also several explanations for this:

Non-sterile suture material.
The body's reaction to a foreign body.

A fistula at the suture after surgery forms a compaction of the suture thread itself, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is not difficult to recognize a fistula after surgery by its characteristic symptoms. They are:

Around the suture in the infected area there is compaction, redness, bumps, and here the body temperature is much higher.
As a rule, at the initial stage, not the entire area of the postoperative suture is inflamed.
Purulent discharge is observed. The less often, the greater their number.
The affected area becomes red, swollen and painful to the touch.
The suture site turns red.
The patient's general condition may worsen, body temperature rises to 38 degrees or higher.

If you experience such symptoms, you need to see a doctor immediately, otherwise the infectious process may spread to your organs or cause blood poisoning.

Diagnosis of fistula

Diagnosing a fistula after surgery is not difficult, since it can be seen visually if it is external. The doctor, after listening to the patient and examining him, pays attention first of all to:

Quantity and quality of discharge.
The size of the fistula, its color.
If the fistula is interorgan, then pay attention to the work of neighboring organs, especially if there are changes.

In order to find out the length and direction of the fistula canal, probing and radiography are used.

It is also necessary to do a series of tests that will confirm the type of fistula. The gastric one will show the presence of hydrochloric acid, and the uric one will show the presence of uric acid salts.

It happens that the suture may begin to fester a long time after the operation, so you need to find out the reason for this phenomenon.

If a fistula does appear after surgery, how to treat it?

Treatment of fistulas

For successful therapy, it is first necessary to:

Eliminate the source of the inflammatory process. If it is a thread, then it is removed.
The doctor must conduct an examination and do a fistulography. This will show whether the fistula has a connection with the internal organs.
Then a mandatory course of antibiotics or anti-inflammatory drugs is prescribed, depending on the depth of the inflammatory process.
To maintain the body, the doctor may prescribe a vitamin complex so that you have more strength to fight germs.
The wound is washed with a syringe with hydrogen peroxide or a furatsilin solution, as these agents are excellent disinfectants and promote rapid healing. The procedure is carried out daily, and if there is a lot of pus, then several times a day.

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulation is removed, and the areas can be cauterized.

The newest method is the treatment of fistula after surgery using ultrasound. This method is considered the most gentle, but it is not fast.

In severe cases, if several fistulas have formed, complete excision of the postoperative scar is indicated. The infected suture material is removed and a new suture is placed.

Postoperative intervention

If you still failed to cure the fistula and had to resort to surgical methods, then after the operation to remove the fistula, healing will take place within several weeks. The wound will heal faster if you provide it with complete rest and proper care.

After surgery for a rectal fistula, the doctor, as a rule, prescribes a diet so that the wound heals faster. After such operations, painkillers and antibiotics are required. The wound heals within a month; any physical activity is avoided.

The prognosis for treatment is usually good and the patient makes a full recovery.

Traditional methods of treatment

Of course, people always try to cure the disease at home. There are several recipes for treating fistulas with folk remedies. Here are some of them.

It is necessary to take vodka and olive oil in equal proportions. Wet a bandage with this mixture and apply to the inflamed area. Apply a cabbage leaf overnight. At least ten such procedures are required.
A mixture of aloe juice and mumiyo is good at drawing pus out of a wound. Mumiyo is diluted with water to the consistency of strong tea. The bandage should be left on for a long time.
It is recommended to wash wounds with a decoction of St. John's wort. You can apply a bandage on top and then wrap it with oilcloth. If the solution is hot, the effect will be greater.
There is a recipe for an ointment that treats not only fistulas, but also non-healing wounds. It is necessary to take equal quantities of flower honey, pine resin, medical tar, butter, aloe leaf pulp, mix the ingredients and heat in a water bath. Dilute with vodka to the desired consistency. Apply ointment around the fistula, then cover with plastic and apply a bandage or plaster. The fistula will heal literally before our eyes.
It is good to apply softened resin. It perfectly draws out pus and heals wounds.
To strengthen the patient's immunity, it is recommended to drink aloe juice with honey. The recipe is as follows: you need to take 12 leaves from a three-year-old plant and leave it in the refrigerator for 10 days. Then finely chop, place in a glass bowl and pour in liquid honey until completely covered. Stir every day and leave for 6 days. Strain the infusion and consume 1 teaspoon 3 times a day before meals. After such a drug, strength appears to fight the disease, and wounds will heal faster.

It is worth noting that if a fistula has formed after surgery, then treatment should be carried out under the supervision of doctors, and folk remedies are an addition to the main course.

Prevention of fistulas

In order to prevent fistulas from appearing after surgery, it is necessary:

First of all, observe the rules of asepsis during surgery.
All instruments and suture material must be sterile.
It is necessary to treat the wound before suturing it.
Vessel doping should occur with little tissue involvement.
Prescribe antibacterial drugs to prevent infections.
It is necessary to treat all infectious diseases, preventing the development of fistulas.