home Auditorium 7 Abscess - symptoms, causes and treatment of abscess. Diagnosis of soft tissue abscess. Local symptoms of the described disease are

Abscess - symptoms, causes and treatment of abscess. Diagnosis of soft tissue abscess. Local symptoms of the described disease are

This is a cavity located in the muscles or subcutaneous fat, delimited from the surrounding tissues and filled with purulent contents. It is characterized by the presence of edema, hyperemia, skin soreness and symptoms of fluctuation in the affected area. Accompanied by general somatic changes: headache, hyperthermia, malaise, sleep disorder. The examination includes examination, ultrasound, radiography, diagnostic puncture of the abscess and bacteriological examination of its contents. After the formation of an abscess, it is opened, followed by postoperative drainage and rinsing with antiseptic solutions.

ICD-10

L02.2 L02.3 L02.4 L02.1

General information

Soft tissue abscess differs from other purulent-inflammatory diseases by the presence of an infiltrative capsule or, as it is also called, a pyogenic membrane. Abscesses of any location, including those located in internal organs, have a similar capsule. The soft tissue abscess capsule limits it from nearby anatomical structures and prevents the spread of the purulent process. However, the accumulation of a significant amount purulent exudate, an increase in the abscess and thinning of its capsule can lead to a breakthrough of the soft tissue abscess with the release of its purulent contents into the surrounding tissue or intermuscular spaces with the development of diffuse purulent inflammation - phlegmon.

Causes

A soft tissue abscess is caused by pyogenic microorganisms entering the tissue. In approximately a quarter of cases, the pathology is caused by staphylococcal infection. Pathogens can also be streptococci, Escherichia coli, Proteus, Pseudomonas aeruginosa, clostridia and other pathogenic microorganisms. Often, soft tissue abscess has a polymicrobial etiology. With bone tuberculosis, a “cold” soft tissue abscess caused by Mycobacterium tuberculosis can be observed.

Penetration of pyogenic microorganisms that cause soft tissue abscesses most often occurs when the integrity of the skin is damaged as a result of wounds, injuries, microtraumas, burns, frostbite, and open fractures. A soft tissue abscess can occur when microorganisms spread by lymphogenous and hematogenous routes from purulent foci existing in the body. For example, boils, carbuncles, pyoderma, etc. Infection with the formation of a soft tissue abscess can occur iatrogenically when injecting with an infected needle. IN in rare cases An aseptic abscess of soft tissues is observed, resulting from the ingress of liquids into the tissues that cause necrosis (kerosene, gasoline, etc.).

According to the observations of specialists in the field of purulent surgery, a background favorable to the development of soft tissue abscess is the presence in the body of a focus of chronic infection (sinusitis, chronic tonsillitis, pharyngitis), long-term disease gastrointestinal tract, peripheral circulatory disorders and metabolic disorders (obesity, hypothyroidism, vitamin deficiency). Diabetes mellitus with severe angiopathy plays a particularly significant role in the development and progression of the purulent process.

Abscess symptoms

Soft tissue abscess is characterized by the presence of local and general somatic symptoms. Local signs include pain, swelling and redness of the skin area located above the abscess. Pressing the affected area causes increased pain. If the soft tissue abscess is located superficially, then the local symptoms are clearly expressed and are complemented by a fluctuation symptom that occurs a few days after the formation of the abscess, indicating the accumulation of liquid contents inside the inflammatory focus.

With a deeply located abscess, its local symptoms are not so noticeable, fluctuation is not observed and changes in the general condition of the patient may come to the fore. General somatic signs of soft tissue abscess are not specific. Patients note increased fatigue, periodic headache, weakness, sleep disturbance, rise in body temperature, which can reach 39-40°C and be accompanied by chills.

Complications

Severe symptoms of intoxication may be associated with the absorption into the bloodstream of toxic substances resulting from the breakdown of tissue inside the abscess, or indicate the spread of a purulent process and the threat of sepsis. A complication of a soft tissue abscess, in addition to sepsis, can be the development of soft tissue phlegmon, purulent melting of the wall of a nearby large vessel, involvement of the nerve trunk in the process with the development of neuritis, spread of the purulent process to hard structures with the occurrence of osteomyelitis of the nearby bone.

Diagnostics

During the diagnostic examination of the patient, the purulent surgeon should pay attention to the presence in his anamnesis of indications of the appearance of inflammatory symptoms after an injury, wound or injection. A superficial soft tissue abscess is easily identified when examining the affected area. Deeper abscesses require soft tissue sonography and diagnostic puncture. After puncture, the resulting material is subjected to bacteriological examination to determine the sensitivity of pyogenic microflora to antibiotics.

If a “cold” abscess is suspected, a x-ray examination affected area and PCR diagnosis of tuberculosis. The patient’s underlying diseases are also diagnosed, which may require consultations related specialists: otolaryngologist, gastroenterologist, endocrinologist.

Treatment of soft tissue abscess

In the initial stage, conservative treatment is recommended: anti-inflammatory therapy and UHF. A formed soft tissue abscess is subject to mandatory surgical treatment. The opening and drainage is usually performed by a surgeon in an outpatient operating room. Hospitalization is necessary in the case of a complicated abscess, recurrence of the abscess after surgical treatment, or the presence of severe background disease or the patient’s condition, anaerobic nature of the infection, high risk of developing postoperative complications when the abscess is located on the face, near large vessels or nerve trunks.

In surgery, open and closed are currently used. surgical treatment soft tissue abscess. The closed method is performed through a small incision. It includes curettage of the walls and aspiration of the abscess contents, the use of a double-lumen tube for drainage, active aspiration and lavage of the cavity after surgery to open the abscess. Open way treatment involves emptying and washing the abscess with an antiseptic after its wide dissection, drainage using wide strips, daily postoperative toileting of the abscess cavity and bandaging.

If opening and drainage of the abscess does not lead to a weakening and gradual disappearance of general somatic and intoxication symptoms, then one should think about the generalization of a purulent infection and the development of sepsis. In such cases, it is necessary to carry out massive antibacterial therapy, detoxification, infusion and symptomatic therapeutic measures.

Prognosis and prevention

Preventing abscess formation in soft tissues consists in following the rules of asepsis and injection technique, using only disposable syringes and needles, timely treatment of purulent processes various localizations, increase nonspecific resistance body, adequate and thorough primary treatment of wounds in case of traumatic injuries.

Soft tissue abscess called a cavity filled with pus (pyogenic membrane or infiltrative capsule) and located in the subcutaneous fatty tissue or muscles. It has clear boundaries that separate it from surrounding healthy tissue.

With the accumulation of a large amount of pus, the affected area enlarges, the capsule becomes thinner and the likelihood of an abscess breaking through with the release of purulent exudate into the nearby healthy tissue and intermuscular spaces increases.

As a result, extensive diffuse inflammation develops, called phlegmon. In addition, the abscess in neglected form can cause sepsis, purulent melting of the walls blood vessel, the nerve trunk (which leads to neuritis) and the adjacent bone (the occurrence of osteomyelitis).

Causes of soft tissue abscess

Penetration of infection into soft tissues when the skin is damaged as a result of injuries, wounds, cuts, frostbite, open fractures, burns. The causative agents are:
- staphylococci, which cause abscess in a quarter of cases;
- Escherichia coli, which often infects tissues along with staphylococci;
- Mycobacterium tuberculosis, which causes a “cold” soft tissue abscess that occurs with tuberculosis of bones and joints;
- streptococci;
- Proteus;
- Pseudomonas aeruginosa;
- clostridia, etc.
Injection under the skin along with medicines infected contents or medications intended only for intramuscular injections. As a result of an abscess that arises for this reason, it may develop aseptic necrosis fiber and purulent melting of soft tissues. The pus remains sterile.
The spread of bacteria through the blood and lymph in the presence of purulent foci in the body: carbuncle, boil, purulent tonsillitis, peritonitis, pyoderma.
Liquids entering the tissues cause necrosis. Such substances include gasoline, kerosene, etc.

Factors contributing to the development of an abscess

These include:

long-term gastrointestinal diseases (enterocolitis, gastric ulcer, duodenitis, chronic gastritis);
peripheral circulatory disorders;
presence in the human body of various chronic infections(tonsillitis, sinusitis, pharyngitis);
metabolic disorders (diabetes mellitus, obesity, vitamin deficiency, hypothyroidism).

The development of post-injection abscess is promoted by:

bedsores, prolonged bed rest and general weakening of the body;
non-compliance with the technique of intramuscular injections, as a result of which the needle enters the vessel with the subsequent development of a hematoma and its infection;
administration of drugs that irritate tissues and penetrate the skin (analgin, magnesium sulfate, caffeine, etc.).

Symptoms and signs

First, an infiltrate without clear boundaries appears on the surface of the skin. Then an abscess forms with characteristic signs:

Pain in the affected area, swelling and redness.
Fluctuation, which is evidence of the accumulation of liquid contents inside the lesion. It is determined as follows: the fingers of both hands are placed in the center of the inflamed area close to each other and pressed on the skin. The fingers of the left hand do not move, but the fingers of the right hand produce light shocks, which, in the presence of liquid in a closed cavity with elastic walls, are transmitted to the left hand. Conversely, shocks produced by the left hand are felt by the fingers of the right.

The closer to the surface the cavity is located and the thinner its walls, the more clearly the fluctuation is determined. With deeply located ulcers it is difficult to detect, so the symptom of the presence of fluid appears late. In the latter case, signs indicating an abscess will be changes in the general condition of the patient.

Sometimes a feeling of false fluctuation may occur (for example, with a lipoma). In this case, shocks from one hand to the other are transmitted only in one direction, and when the position of the hands changes, the feeling of swaying disappears.

General somatic changes:

weakness, weakness and increased fatigue;
headache;
high body temperature, reaching 39-40 degrees and accompanied by chills;
sleep disturbance;
loss of appetite.

These symptoms are nonspecific and indicate general intoxication of the body, resulting from the absorption into the blood of toxins that are formed as a result of the breakdown of tissues inside the affected cavity. Such signs may also indicate the spread of a purulent process with a high probability of developing sepsis.

Signs of post-injection abscess

temperature increase;
the presence of an infiltrate at the injection site, upon pressure on which pain occurs, increasing 4-6 days after the injection (usually in the gluteal region);
swelling and redness of the skin;
fluctuation appears 2-3 days after injection.

Diagnostics

First of all, specialists inspect the affected area. This diagnostic method is sufficient for superficial tissue damage. If the cavity with purulent contents is deep, it is referred for ultrasound or x-ray examination.

For any form of abscess, a diagnostic puncture of the infiltrate is performed using a thick needle and examination of the bacteria contained in the pus. This is necessary in order to determine the sensitivity of microorganisms to antibiotics for the purpose of prescribing adequate therapy. If a “cold” soft tissue abscess is suspected, the patient is sent for an x-ray and PCR tests for tuberculosis.

The patient's underlying diseases must be identified. Their diagnosis may require consultation with an endocrinologist, gastroenterologist or otolaryngologist.

Treatment of soft tissue abscess

It's important to start timely treatment diseases. In its absence, there is a high probability of sepsis with abundant flow of pus into the cellular spaces.

In the early stages, with superficial tissue damage, cold treatment is prescribed, which can lead to the resorption of pus. If there is no improvement, but fluctuation is not yet detected, then proceed to the use of heat. These can be warming compresses, heating pads, physiotherapeutic procedures. If there is a cavity filled with fluid, opening the abscess through surgery, involving its incision and drainage, is indicated.

After surgery, wound treatment is required to prevent the edges from sticking together until the cavity granulates from the depths. To do this, a loose swab with Vishnevsky ointment is left in the operated tissues, Vaseline oil and so on. It has an irritating effect, causing the development of granulations. It is changed during dressings every 2-3 days, introducing it loosely until it comes into contact with the bottom of the cavity.

As granulation develops, the tampon is pushed out of the depths. At this time, apply rare bandages with the same Vaseline oil or Vishnevsky ointment until the wound is completely healed. Excess granulations are cauterized with lapis, being careful not to touch the epithelium that grows along the edges of the wound, and its islands along the surface of the damaged area. If the wound heals slowly and the granulations are clean and juicy, then suturing is indicated.

For deep-lying abscesses, a closed treatment method is used, which allows to reduce the treatment time for the disease. This happens in several stages:

The surface is treated with an antiseptic.
Held local anesthesia(most often lidocaine).
A small incision of no more than 2 cm is made and expanded using a Hartmann syringe to 4-5 cm with simultaneous rupture of the connecting bridges of the cavity.
Scraped internal walls cavity filled with pus (curettage), and its contents are sucked out (aspiration).
The abscess is drained using a special tube for draining fluid (double-lumen drainage), which ensures the outflow of purulent exudate. At the same time, active suction and rinsing of the cavity with an antiseptic is performed.

The operation is performed on an outpatient basis and lasts no more than 10 minutes. The wound treatment period is up to a month.

Post-injection abscess on initial stage, until purulent melting occurs, they are treated conservatively: with anti-inflammatory drugs and antibiotics. UHF is also prescribed. If an abscess occurs, surgical intervention is required.

After opening the abscess, antibiotics are prescribed. Their use before surgery is ineffective, since purulent formations are not supplied with blood, and active substances cannot enter the damaged area.

Antibiotics for the treatment of abscess

Before their appointment, a culture of pus is done to determine the type of pathogenic microorganisms and their sensitivity to antibiotics. There are several treatment options:

local application,
oral administration,
injection of medications into the affected area (done when treating an oral abscess).

Antibiotics are used penicillin series(cephalexin, amoxicillin) for 10 days, 4 times a day, 250-500 mg. If the patient is allergic to penicillin, macrolides (clarithromycin, erythromycin) are prescribed, which are also taken for 10 days at 250-500 mg, but 2 times a day.

Antibiotics for external use include ointments (Levomekol, Mafenid, Levosin, etc.), the use of which leads to recovery in 1-2 weeks. Their advantage is that the drugs act only at the site of the lesion, without being absorbed into the blood.

In addition to antibiotics, antipyretics (at high temperatures), non-steroidal anti-inflammatory drugs and sulfonamides (0.5-1 g of streptocide 3-4 times a day) are also prescribed.

Prevention

To prevent the occurrence of an abscess, it is necessary to take measures aimed at eliminating the possibility of infection entering the soft tissues and general strengthening body.

Proper treatment of wounds and their timely treatment

In case of injury, first of all, it is necessary to remove visible contamination with a sterile bandage or tweezers disinfected with alcohol. A clean wound should be treated with an antiseptic, and then the damaged area should be covered with a bandage or plaster, protecting it from re-contamination. It is important to change the bandage daily until the damaged skin is completely healed.

For wound treatment use: chlorhexidine biglucanate, iodine, 3% hydrogen peroxide. The latter destroys microorganisms both chemically and mechanically, bringing them to the surface due to the formation of bubbles. If medications are not available, then any alcohol solution will be suitable as an antiseptic.

For deep wounds, the above procedures will not be enough. It is necessary to consult a doctor who will treat the wound, excise its edges, stop the bleeding and apply stitches. If necessary, a course of antibacterial therapy is prescribed.

Increased nonspecific resistance of the body

It is possible to artificially increase the body's resistance to any damage through immunization and the introduction of convalescent gamma globulin or serums. In folk medicine, cauterization, creation of foci of artificial inflammation, acupuncture, and ginseng are used. Traditional medicine methods:

Autohemotherapy, which involves administering intramuscularly to the patient his own blood taken from a vein.
Administration of antireticular cytotoxic serum - a biostimulant obtained from the blood serum of animals (usually donkeys and horses) that have been immunized with an antigen from bone marrow and spleens of tubular bones taken from young animals or from a human corpse within 12 hours after his death.
Protein therapy is the introduction of protein substances into the body parenterally (not through the gastrointestinal tract): intramuscularly or intravenously.

Compliance with the technique of performing intramuscular injections

Necessary:

Follow the rules of asepsis. Injections must be given under completely sterile conditions. This also applies to the room in which the procedure is performed.
Use drugs that cause tissue irritation (such as analgin) only with novocaine.
Make injections alternately in different directions of the gluteal region.
Use disposable needles and syringes. If this is not possible, be sure to autoclave needles and syringes.

Forbidden:

using clogged injection needles that have been cleaned with a mandrin.
use for intramuscular injections of needles, which are intended for administering drugs under the skin and into a vein, since the subcutaneous tissue is too thick for them (reaches 8-9 cm).

Which doctor should I contact?

Abscess is purulent inflammation tissues with the formation purulent cavity. It can occur in muscles, bones, subcutaneous tissue, in and between organs. An abscess can develop independently or as a complication of other diseases (trauma, pneumonia, tonsillitis).

When a large volume of exudate accumulates, the capsule may rupture, followed by the release of pus. This becomes the cause of the development of an inflammatory process, which can cause sepsis, purulent melting of a blood vessel and others, no less dangerous consequences. That is why it is necessary to know how to treat an abscess on early stage.

Abscess refers to surgical diseases and often requires surgical intervention. A neglected abscess can lead to serious complications.

Abscess: causes and development factors

Like any other purulent disease, an abscess develops as a result of a violation of the integrity of the skin and the entry of pathogenic pyogenic bacteria into the body. When pyogenic bacteria multiply, the skin melts and a capsule is formed, which is filled with purulent masses. It is noteworthy that some bacteria that can cause an abscess are part of normal microflora. However, under certain conditions, these bacteria begin to multiply uncontrollably, forming purulent masses. A large number of such microorganisms live on the mucous membranes of the mouth, nasal cavity, genitals, mucous membrane of the eyes, in the small and large intestines.

Note that identifying the pathogenic causative agent of an abscess can be quite difficult. But the effectiveness of treatment depends on the accurate identification of the microorganism. Exists a large number of pathogenic bacteria that can cause soft tissue abscess. We will consider only those microbes that doctors most often encounter in surgical practice:

Staphylococcus aureus (Staphylococcus aureus). In the vast majority of cases, the cause of a skin abscess is Staphylococcus aureus. According to the latest medical research, Staphylococcus aureus is detected in 28% of cases of skin abscess. Almost always, Staphylococcus aureus is sown in pure culture, without accompanying microflora. In approximately 47% of cases, abscesses develop in the upper half of the body (abscesses of the neck, face, chest and axilla) and are caused by Staphylococcus aureus. Some strains Staphylococcus aureus are not sensitive to antibiotics, which makes it difficult to treat such abscesses.
Proteus mirabilis. This is one of the common microorganisms that lives in the large intestine and is isolated during microscopic examination of stool. This microorganism is often the cause of the development of abscesses in the lower half of the body.
Escherichia coli. This is a representative of the normal intestinal microflora. However, under some circumstances, such as when the immune system is weakened, E. coli can cause serious and even fatal illness.
Medications. Some medications can cause sterile abscesses that look like cellulite on the skin.
Some diseases. In some cases, some diseases (for example, pharyngitis, paraproctitis, ingrown nails, Crohn's disease, osteomyelitis and others) can be complicated by the occurrence of an abscess.

Types of disease: classification of abscess

soft tissue abscess (in fatty tissue, muscles, cold abscess with bone tuberculosis);
appendicular abscess (as a complication acute appendicitis);
Bezold's abscess (deep abscess under the neck muscles);
lung abscess;
brain abscess;
retropharyngeal abscess;
pelvic abscess;
paratonsillar abscess (complication of tonsillitis);
liver abscess (bacterial, amoebic);
interintestinal abscess (between intestinal loops and abdominal wall);
subphrenic abscess (as a result of surgery, trauma, etc.);
spinal epidural abscess (damage to the tissue surrounding the membranes of the spinal cord).

Abscess symptoms: how the disease manifests itself

Superficial abscesses are characterized by classic manifestations acute inflammation: redness of the skin, local pain, local fever, swelling, dysfunction of the organ. General symptoms of an abscess are typical for inflammatory processes of any location: headache, general malaise, fever, loss of appetite, weakness.

The outcome of an abscess can be:

breakthrough with emptying into closed cavities (joint cavity, pleural, abdominal, etc.);
spontaneous opening with a breakthrough to the outside (with mastitis, paraproctitis, abscess subcutaneous tissue);
breakthrough into the lumen of organs that communicate with the external environment (bronchi, intestines, stomach, bladder).

After opening the abscess, the cavity emptied when favorable conditions collapses and undergoes scarring. When incomplete emptying abscess cavity or poor drainage inflammatory process can go to chronic form with the formation of fistulas. A breakthrough into closed cavities leads to the occurrence of purulent processes in them (pericarditis, pleurisy, arthritis, peritonitis, meningitis, etc.).

As for the symptoms of abscess of individual organs, they look like this:

Throat abscess. With a paratonsillar or retropharyngeal abscess of the throat, the patient experiences pain in the throat when swallowing, and with swelling, suffocation. This is the most dangerous complication at purulent abscess throat. If in this case the patient is not provided with medical assistance in a timely manner, this can lead to death.
Brain abscess. In the initial stages, a brain abscess is accompanied by localized severe pain, which is caused by increased intracranial pressure. More often these painful sensations occur in the morning. On late stages development of the pathological process in a person may develop delusions and hallucinations. With purulent lesions of the cerebellum, coordination of movements and orientation in space are impaired.
Lung abscess. With a lung abscess, the patient experiences a severe cough with purulent sputum. The patient's breathing is very difficult, and in the chest area there are painful sensations. At the initial stages of the pathological process, diagnosing a lung abscess is quite difficult.

Complications of an abscess

The most common complications: spread of infection, bacteremia (bacteria entering the blood), abscess rupture (outside or into adjacent cavities and tissues), arrosive bleeding. With inadequate drainage of the abscess or late surgery, generalization of the infection and transition of the inflammatory process to a chronic form are possible.

Long-term consequences of an abscess are dysfunction of vital important organs, as well as exhaustion caused by tissue breakdown, anorexia.

What to do if you have an abscess

If signs of an abscess occur, you should consult a surgeon. It is unacceptable to open an abscess on your own due to the risk of developing serious complications.

Treatment of a formed abscess cannot be done without surgical intervention. This therapeutic event is carried out by a surgeon in the operating room.

The patient may be hospitalized for an indefinite period of time in an inpatient setting in the case of a complicated abscess, in case of relapse of the pathology after surgery, in the presence of a severe underlying disease, or a high risk of complications. In addition, a person is hospitalized if the abscess is located near a large vessel or nerve trunk.

An abscess can be eliminated open or closed. A closed operation involves making a small incision through which the contents of the tumor are removed and a special tube is inserted for drainage. Afterwards, the cavity is washed with a disinfectant and a bandage is applied.

Open surgery consists of removing exudate from the abscess cavity, which is carried out after a wide dissection of the neoplasm. A drainage tube is also used and the dressing is changed daily.

In the event that even the operation did not help eliminate unpleasant symptoms, generalization of infection with the development of sepsis may occur. In this case, antibiotic therapy, symptomatic treatment, and detoxification therapy are carried out.

Diagnosis of an abscess

A doctor can easily recognize a superficial abscess, but a deep abscess is much more difficult to diagnose. In diagnosis, a blood test is used (a shift in the formula to the left, an increase in the number of leukocytes and ESR are observed). An X-ray, ultrasound, computed tomography, or magnetic resonance imaging may be performed to determine the location and size of the abscess.

Differential diagnosis of an abscess is carried out with phlegmon, characterized by the absence of limitation. Hematoma, cysts and tumor-like formations with associated infection also have similar symptoms. To clarify the diagnosis, a puncture of the contents is performed, which makes it possible not only to determine the nature of the formation, but also the pathogen, and this greatly facilitates further treatment.

Abscess treatment

If an abscess occurs, it is indicated surgery, the purpose of which is to open the purulent cavity, empty it, and then drain it. Opening of small superficial abscesses can be performed on an outpatient basis.

An alternative surgical intervention in the case of small localized abscesses of subcutaneous fat, the use of ointments Elon K. The product should be applied under sterile bandage or a patch once or twice a day. At correct use the ointment promotes the maturation and subsequent opening of the abscess, while the purulent contents are completely eliminated, which prevents the encapsulation of purulent foci of infection and the recurrence of the inflammatory process. You can find Elon K ointment in pharmacies.

In case of abscesses of internal organs, urgent hospitalization in a surgical hospital is necessary. Some types of abscess (for example, lungs, liver) are treated by puncture with aspiration of pus and the introduction of antibiotics and enzyme preparations into the abscess cavity.

Resection of the affected organ (for example, lung) along with an abscess is indicated when chronic course. After opening the abscess, patients are provided with a balanced diet and detoxification therapy. Antibacterial agents prescribed taking into account the sensitivity of the inoculated microflora to them.

At an early stage cold treatment (compresses) is used, which promotes the resorption of the purulent mass. If this is ineffective and there are no negative changes (for example, an enlarged cavity or pronounced suppuration), heat compresses (a heating pad, etc.) are used.

In the treatment of ulcers use antibacterial drugs in the form of tablets, ointments, or as injections into the affected area. Before prescribing the drug, a culture of the purulent mass is done, which helps to identify the type pathogenic microorganism and its sensitivity to drugs. In most cases, penicillins are used. This may be Cephalexin, Amoxicillin, which are prescribed in daily dosage 250-500 mg four times a day. The approximate duration of therapy is 10 days.

In the treatment of abscesses You can use local drugs. For example, if an abscess has formed in a child, Bepanten ointment will be an effective treatment, which quickly copes with the inflammatory process and accelerates wound healing.

For an adult, ointments such as Levomekol, Vishnevsky, Ichthyol are perfect. The first (Levomekol) has a powerful anti-inflammatory effect, as well as an antiseptic. The advantage of the medicine is the elimination of both the symptoms of the abscess and its cause. The ointment has few side effects.

Vishnevsky ointment is used in the treatment of abscesses, as well as carbuncles and boils, trophic and varicose ulcers. The only contraindication is hypersensitivity to the components medicine. There are no other contraindications, as well as side effects from application.

Folk remedies

A soft tissue abscess can also be cured using traditional medicine, but only if the pathology occurs at the initial stage. Aloe will be effective - a plant that is used to apply compresses and lotions to the affected area. A piece of gauze is moistened in aloe juice, applied to the abscess and left for 24 hours, then replaced with a new one.

You can use rye bread, which is pre-steamed and applied to the abscess. The compress is fixed on top cabbage leaf and bandaged. Leave for 24 hours, then replace the compress with a new one.

Onions are also effective, a compress from which helps speed up the maturation of the abscess and its breakthrough. The fresh onion is grated, the pulp is spread on a piece of gauze, then on the abscess, left for 5 hours. The onion can be boiled in milk, then applied to the wound and bandaged.

Propolis ointment has healing properties. It is prepared as follows: melt animal fat (100 g), add crushed propolis (10 g), simmer for another 7 minutes. Next, remove from heat, cool and strain through a gauze filter. Ready product use as a compress, leaving for 2 hours. Carry out the procedure three times a day.

Another useful product beekeeping - honey An ointment is prepared from it: an equal volume is mixed with Vishnevsky ointment and alcohol to obtain a homogeneous consistency. The finished product is spread on gauze, then on the abscess, leaving until the morning. The procedure is carried out at night.

An abscess (abscess, abscess) is a purulent inflammation accompanied by the melting of tissue and the formation of a cavity filled with pus. It can form in muscles, subcutaneous tissue, bones, internal organs or in the tissue surrounding them.

Abscess formation

Causes of abscess and risk factors

The cause of the abscess is pyogenic microflora, which enters the patient’s body through damage to the mucous membranes or skin, or is carried through the bloodstream from another primary source of inflammation (hematogenous route).

The causative agent in most cases is a mixed microbial flora, in which staphylococci and streptococci predominate in combination with various types sticks, for example coli. IN last years The role of anaerobes (clostridia and bacteroides), as well as the association of anaerobic and aerobic microorganisms in the development of abscesses, has significantly increased.

Sometimes there are situations when the pus obtained during opening of an abscess, when inoculated on traditional nutrient media, does not give rise to the growth of microflora. This indicates that in these cases the disease is caused by uncharacteristic pathogens, which cannot be detected by conventional diagnostic techniques. To a certain extent, this explains cases of abscesses with an atypical course.

Abscesses can occur as an independent disease, but more often they are a complication of some other pathology. For example, pneumonia can be complicated by a lung abscess, and purulent tonsillitis - by a peritonsillar abscess.

With the development of purulent inflammation, the body's defense system seeks to localize it, which leads to the formation of a limiting capsule.

Forms of the disease

Depending on location:

Subcutaneous tissue abscesses usually result in complete recovery.

By features clinical course The following forms of abscess are distinguished:

Hot or spicy. Accompanied by a pronounced local inflammatory reaction, as well as a violation of the general condition.
Cold. It differs from a regular abscess in the absence of general and local signs of the inflammatory process (fever, redness of the skin, pain). This form of the disease is characteristic of certain stages of actinomycosis and osteoarticular tuberculosis.
Natechny. The formation of an area of pus accumulation does not lead to the development of acute inflammatory reaction. Abscess formation occurs over a long period of time (up to several months). Develops against the background of the osteoarticular form of tuberculosis.

Abscess symptoms

The clinical picture of the disease is determined by many factors and, above all, the location of the purulent process, the cause of the abscess, its size, and the stage of formation.

Symptoms of an abscess localized in the superficial soft tissues are:

swelling;
redness;
severe pain;
increase in local, and in some cases general temperature;
dysfunction;
fluctuation.

Abdominal abscesses are manifested by the following symptoms:

intermittent (intermittent) fever with a hectic type of temperature curve, i.e., subject to significant fluctuations during the day;
severe chills;
headache, muscle and joint pain;
lack of appetite;
severe weakness;
nausea and vomiting;
delayed passage of gas and stool;
tension in the abdominal muscles.

When the abscess is localized in the subdiaphragmatic region, patients may experience shortness of breath, cough, pain in the upper abdomen, which intensifies during inspiration and radiates to the scapula and shoulder.

With pelvic abscesses, reflex irritation of the rectum occurs and Bladder, which is accompanied by the appearance of tenesmus (false urge to defecate), diarrhea, and frequent urination.

Retroperitoneal abscesses are accompanied by pain in lower parts back, the intensity of which increases when bending the legs at the hip joints.

Symptoms of a brain abscess are similar to the symptoms of any other space-occupying formation (cysts, tumors, etc.) and can vary very widely, ranging from a minor headache to severe cerebral symptoms.

A lung abscess is characterized by a significant increase in body temperature, accompanied by severe chills. Patients complain of chest pain, worsening when trying to take a deep breath, shortness of breath and dry cough. After opening the abscess into the bronchus, a strong cough occurs with copious discharge of sputum, after which the patient’s condition begins to quickly improve.

Abscesses in the oropharynx (retropharyngeal, paratonsillar, peripharyngeal) in most cases develop as a complication of purulent tonsillitis. They are characterized by the following symptoms:

severe pain radiating to the teeth or ear;
feeling foreign body in the throat;
muscle spasm that prevents mouth opening;
soreness and swelling of regional lymph nodes;
increased body temperature;
weakness;
nasal voice;
the appearance of an unpleasant putrid odor from the mouth.

Diagnosis of an abscess

Superficially located soft tissue abscesses do not cause diagnostic difficulties. With a deeper location, it may be necessary to perform an ultrasound and/or diagnostic puncture. The material obtained during puncture is sent for bacteriological examination, which allows identifying the causative agent of the disease and determining its sensitivity to antibiotics.

Oropharyngeal abscesses are identified during an otolaryngological examination.

Abscesses can occur as an independent disease, but more often they are a complication of some other pathology. For example, pneumonia can be complicated by a lung abscess, and purulent tonsillitis can be complicated by a peritonsillar abscess.

Much Diagnosis is more difficult abscesses of the brain, abdominal cavity, lungs. In this case, it is carried out instrumental examination which may include:

Ultrasound of the abdominal and pelvic organs;
magnetic resonance or computed tomography;

Abscess treatment

In the initial stage of development of abscess of superficial soft tissues, anti-inflammatory therapy is prescribed. After the abscess has matured, it is opened, usually on an outpatient basis. Hospitalization is indicated only in severe general condition of the patient and the anaerobic nature of the infectious process.

As aid during treatment, as well as for the prevention of complications of abscesses of subcutaneous fat, it is recommended to use Elon ointment. The ointment should be applied to the affected area under a sterile gauze bandage or a patch. Depending on the degree of suppuration, the bandage must be changed once or twice a day. The duration of treatment depends on the severity of the inflammatory process, but, on average, to obtain a satisfactory result, you need to use the ointment for at least five days. Elon K ointment is sold in pharmacies.

Treatment of a lung abscess begins with the prescription of broad-spectrum antibiotics. After receiving an antibiogram, antibiotic therapy is adjusted taking into account the sensitivity of the pathogen. If there are indications, in order to improve the outflow of purulent contents, perform bronchoalveolar lavage. Inefficiency conservative treatment an abscess is an indication for surgical intervention - resection (removal) of the affected area of the lung.

Treatment of brain abscesses in most cases is surgical, as they can lead to brain dislocation and cause fatal outcome. A contraindication to the removal of abscesses is their localization in deep and vital structures (subcortical nuclei, brain stem, thalamus). In this case, they resort to puncture of the abscess cavity, removal of purulent contents by aspiration, followed by washing the cavity with an antiseptic solution. If repeated rinsing is required, the catheter through which it is carried out is left in the cavity for some time.

Prevention

Prevention of the development of abscesses is aimed at preventing the entry of pathogenic pyogenic microflora into the patient’s body and includes the following measures:

careful adherence to asepsis and antisepsis when carrying out medical interventions accompanied by damage to the skin;
timely implementation of primary surgical treatment wounds;
active sanitation of foci of chronic infection;
increasing the body's defenses.

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An abscess of the soft tissues of the extremities is a cavity formed in them with pus. Most often, this pathology develops in the muscles or subcutaneous fat. Thanks to the formed capsule, the cavity is delimited from the surrounding tissues, which protects against the spread of pus into them. But as the abscess progresses, it spontaneously opens, its infected contents enter neighboring tissues, which can be fraught with the development of severe complications.

Unlike abscesses of internal organs, an abscess of soft tissues of the extremities is located almost superficially, and its diagnosis is not complicated. But in some controversial cases it is necessary to resort to additional instrumental methods diagnostics

Treatment of abscess of soft tissues of the extremities is surgical: the abscess is opened, the pus is removed. Conservative therapy is also involved, but this is an additional method of treatment.

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Total information

Abscess of soft tissues of the extremities is their most common purulent pathology. In terms of frequency of occurrence, it can compete, perhaps, only with the soft tissues of the same location - a diffuse purulent lesion that has no boundaries due to the absence of a capsule. Quite often, these two diseases “complement” each other - an abscess can be complicated by the development of phlegmon, and against the background of phlegmon, limited abscesses can form.

Often, such an abscess forms in thick masses of soft tissue - in the area of the forearm, upper arm, thigh, and lower leg.

note

Abscess of soft tissues of the extremities can occur at any age - from early period after birth and ending old age. In the latter case, the incidence rate decreases, since due to age-related changes tissue reactivity decreases.

Causes

The direct cause of the formation of an abscess in the soft tissues of the extremities is pathogenic microflora. These may be pathogens:

nonspecific - they provoke the development of a number of different purulent-inflammatory infectious pathologies;
specific - such infectious agents cause only certain infectious pathologies that cannot be caused by other pathogens.

An abscess of the soft tissues of the extremities develops, as a rule, when pyogenic microorganisms enter them - but also non-pyogenic pathogenic microflora can also trigger its development. As the culture results show, almost any infectious agent, once in the subcutaneous fatty tissue or muscles, is capable of starting the process of suppuration in them. Most often these are pathogens such as:

– , epidermal, saprophytic, hemolytic;
. These are mainly so-called facultative anaerobes (those that require an oxygen-free environment for reproduction and development), although aerobes can also provoke the formation of an abscess (they are able to develop in an oxygen-containing environment);
representatives intestinal infections- first of all, this is;
pneumococci;
mycobacteria.

But, as culture results demonstrate, a mixture of infectious pathogens - two or more - often plays a role in the formation of a soft tissue abscess of the extremities. In approximately 25% of all cases of this pathology, a staphylococcal infection is detected in the pus.

An abscess of soft tissues of the extremities can be:

primary;
secondary.

In the first case, the pathogenic microflora initially enters the soft tissues and provokes their suppuration. In the second case, the infectious agent spreads to the subcutaneous fatty tissue and muscle masses of the limbs from infectious foci, which previously already existed in the body.

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If tuberculosis has developed, a so-called “cold” abscess of the soft tissues of the extremities may occur. Pus flows into them from the primary focus, the body restricts it from healthy tissues using the pyogenic membrane, in this way an abscess is formed.

As a rule, penetration of pyogenic microorganisms into the soft tissues of the extremities occurs in case of damage to their skin due to:

Infection of the soft tissues of the extremities with the formation of an abscess, which is observed during medical procedures, occurs if such manipulations were carried out in violation of the rules of asepsis. Most often this is observed when the rules for sterilizing instruments are violated. Such medical procedures can be both diagnostic and therapeutic.

Infection of the soft tissues of the extremities with the subsequent occurrence of an abscess most often occurs with such diagnostic procedures, How:

diagnostic tissue puncture;
– collection of tissue fragments for diagnostic purposes.

A similar infection can occur during medical manipulation of tissues - often this is:

removal of tumors;
plastic surgery.

A secondary abscess of the soft tissues of the extremities is formed if the body has already developed such acute purulent-inflammatory pathologies as:

– purulent inflammation of the hair follicle;
– purulent-inflammatory lesion of the hair follicle with involvement of adjacent soft tissues;
furunculosis - the formation of several boils;
carbunculosis – the formation of several carbuncles;
abscess of another location;
phlegmon of any localization;
pyoderma - damage to the superficial layers of the skin in the form of small multiple purulent foci;
purulent wound;
– formation of pus in the lacunae of the palatine tonsils;
– inflammatory lesion of the pleura;
pericarditis – inflammation of the pericardium (heart sac);
– inflammatory process in the layers of the peritoneum. It is often purulent, but banal catarrhal peritonitis without suppuration can also cause microorganisms to enter the blood, and with them, migration into the soft tissues of the extremities with subsequent formation of an abscess.

The formation of an abscess of the soft tissues of the extremities can also be caused by chronic foci of infection - most often these are:

– inflammation of the frontal sinuses;
– inflammatory lesions of the maxillary sinuses;
ethmoiditis is a pathological process of inflammatory nature in the sinuses of the ethmoid bone;
– inflammation of the cells of the sphenoid bone;
– inflammation of the mucous membrane lining the pharynx

and some others.

Theoretically, any infectious focus in the body can become a “supplier” of microorganisms for the subsequent formation of an abscess of the soft tissues of the extremities.

A separate case is the formation of an abscess of the soft tissues of the extremities during the suppuration of a hematoma (collection of blood). Blood is one of the best environments for the growth and reproduction of microorganisms. Initially, the hematoma itself is sterile, but pathogenic bacteria, having reached it through hematogenous, lymphogenous or contact routes, infect it.

A number of factors have been identified that are not the direct cause of the described pathology, but contribute to its occurrence. These are groups of factors such as:

vascular;
exchange;
endocrine
somatic;
immune.

Peripheral circulatory disorder due to vascular problems leads to a deterioration in the blood supply to tissues, they are less restored, and because of this, local immunity suffers - the chances of an abscess increasing.

Failures of any metabolic processes are fraught with the formation of an abscess of the soft tissues of the extremities for the same reasons - due to disruption of tissue metabolism.

From endocrine disorders highest value for the formation of an abscess in the soft tissues of the extremities, there is a violation of carbohydrate metabolism due to a lack of insulin. Patients with diabetes mellitus It is especially difficult to tolerate purulent-inflammatory processes, since their tissue regeneration deteriorates several times.

Of somewhat less importance are such endocrine disorders, How:

– decreased hormone production thyroid gland;
– increased synthesis of thyroid hormones.

Somatic diseases play an indirect role in the occurrence of purulent-inflammatory pathologies in general and soft tissue abscess of the extremities in particular. Against their background, the body’s resistance to the harmful effects of the infectious agent weakens. Such contributing pathologies can be diseases of any organs:

(IHD) – oxygen starvation of the heart muscle due to impaired cardiac blood flow;
– defeat respiratory tract, manifested by attacks and suffocation;
and duodenum - a deep defect in their wall;
– inflammatory damage to the liver parenchyma

and many others.

The risk of developing a soft tissue abscess of the extremities increases with a decrease in the body's resistance (local and general immunity).

Development of pathology

An infectious agent can enter the soft tissues of the extremities in several ways:

hematogenous - with blood flow;
lymphogenous - with lymph flow;
contact - directly migrating from neighboring tissues.

The adaptation period of pathogens in tissues is quite short - on average from several hours to 1-1.5 days. After this, the infectious agent becomes active, begins to multiply and release its waste products into the tissue.

They, as well as the decay products of dead microbial bodies, provoke irritation of the subcutaneous fatty tissue and muscle tissue of the extremities. Local immunity is triggered, cells arrive at the source of infection in the tissues immune system– mainly leukocytes and macrophages (eater cells that absorb microbial bodies). The pus that forms when an abscess forms is the body of leukocytes. Its amount accumulates, and at the same time the body tries to separate the purulent contents from healthy tissues - as a result of this, a pyogenic membrane is formed, and an abscess cavity appears.

The difference between a soft tissue abscess of the extremities and other purulent-inflammatory pathologies lies in the presence of the so-called infiltrative capsule, which forms the abscess cavity (its other name is the pyogenic membrane). An abscess capsule of the soft tissues of the extremities is formed as a result of infiltrative processes in the tissues that directly border the pus. If such a capsule were absent, the number of complications associated with the spread of pus from the abscess to healthy tissue would increase by 3-5 times.

The pyogenic membrane has a small margin of safety - it is quite thin and easily breaks through, the purulent contents penetrate into the surrounding tissues.

The reasons for the destruction of the capsule are as follows:

accumulation of a significant amount of purulent exudate - it becomes “cramped” in the limited space of the abscess;
increased pressure of pus in the abscess;
thinning of the capsule - its tissues are attacked by elements of the organism’s immune system.

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When an abscess breaks, pus penetrates into the surrounding tissue or intermuscular spaces of the affected limb according to the principle of least resistance, although in some cases it “paves” its way in the form of a fistula (pathological course), corroding soft tissue.

Symptoms

Abscess of soft tissues of the extremities is a typical purulent-inflammatory process. It is characterized by local and general manifestations.

Local symptoms the disease described is:

swelling;
redness of the skin over the abscess;
increase in local body temperature;
pain syndrome;
dysfunction of the limb.

Characteristics of pain:

by localization - in the area of the abscess;
by distribution - first local, then can cover neighboring tissues;
by nature - twitching;
in terms of intensity - weak at first, intensifying as pus accumulates;
by occurrence - they develop almost immediately with the formation of an abscess.

A small abscess does not significantly affect the functionality of the upper and lower limbs. But with him large size movements in the joints may be accompanied by severe pain, which is why the patient spares them and therefore limits activity on the affected limb.

If the abscess is located superficially in the soft tissues, then the described symptoms appear clearly. With pronounced fatty tissue, as well as with the formation of an abscess deep in the muscle masses, local symptoms can be smoothed out; they will be more pronounced general symptoms, which introduces confusion into the diagnosis.

Signs of a violation of the general condition of the body are observed due to intoxication syndrome - due to the entry of toxic waste products of microorganisms into the blood, and with it into other organs and tissues. The symptoms are as follows:

increase in body temperature - on average up to 37.8-38.5 degrees Celsius. Sometimes body temperature can rise to 40 degrees and be accompanied by chills. This can be observed when the abscess is large or the microorganisms are highly pathogenic (the ability to provoke an infectious process);
general weakness;
malaise;
deterioration in working capacity – both physical and mental;
loss of appetite.

Diagnostics

The diagnosis is made on the basis of the patient’s complaints, medical history (past infectious disease, medical manipulation, trauma and so on), as well as additional methods research.

Physical examination reveals the following:

When the doctor asks the doctor to move his arm or leg, the patient spares the affected limb.

Instrumental methods that can be useful in diagnosing soft tissue abscess of the extremities are:

diagnostic puncture - performed when there are symptoms of intoxication, but local signs abscess is very doubtful. This can be observed when the abscess is deep in the soft tissues of the extremities. In this case, after treating the skin over the abscess, the soft tissue is punctured with a sterile needle on a syringe, pus, if present, is sucked out and sent to the laboratory for study;
(ultrasound) – performed for the same purpose;
– carried out if the formation of a “cold” abscess is suspected.

Laboratory research methods used in the diagnosis of soft tissue abscess of the extremities are as follows:

Differential diagnosis

Differential diagnosis of soft tissue abscess of the extremities is carried out with such diseases and pathological conditions as:

tumors (benign and malignant);
foreign body;
phlegmon;

Complications

The most common complications of soft tissue abscess develop:

Treatment of soft tissue abscess

Abscess of soft tissues of the extremities is eliminated through surgery. If the abscess is small, then it is opened in a purulent dressing room. surgical hospital or outpatient department. Large abscesses and those located deep in the muscle masses of the extremities are opened in a purulent operating room, as anesthesia may be required.

The operation scheme is as follows:

Prescriptions in the postoperative period are as follows:

rest of the limb;
dressings;
taking into account the sensitivity of the pathogen to antibiotics;
painkillers;
vitamin therapy;
infusion therapy - it is carried out with severe intoxication syndrome. Saline solutions, electrolytes, blood plasma, and fresh frozen serum are injected intravenously.