Purulent fistula after surgery. Fistula after caesarean section, fistula on the neck

A fistula after a caesarean section is one of the most common problems that is directly related to the operation and is dangerous because it provokes entry into female body various pathological microorganisms that stimulate the development of infectious processes.

After any operation, special sutures are applied to help rapid healing. Doctors treat the incision to stop the bleeding in time and prevent massive blood loss. The material of all seams is a ligature. It does not cause women any further complications.

Before sewing up a cut, experienced specialists treat it with high quality so that bacteria do not get inside. If this is not done, inflammatory processes will develop that will provoke the appearance of a fistula. Any penetration into the suture material causes pus to form. It subsequently flows out, the passage is called a fistula. The liquid can make its way into one hole or into several, so many ligature fistulas can appear simultaneously.

Photo fistula after cesarean

The complication develops within 4 days after the caesarean section, up to several months. When the inflammatory processes pass, the fistulas close for a while, but there will be no recovery until the doctors eliminate the source of suppuration.

Fistula definition

A fistula is an opening in the form of a passage connecting certain openings in the body, organ systems with each other or with environment. It looks like a narrow gap, which is lined with fabric. Fistulas are formed as a result of suturing after operations, as well as due to inflammatory processes occurring inside the human body.

Purulent fluid is formed due to the cessation of inflammatory processes. The hole through which this fluid flows out then completely heals. But if the infection is not completely suppressed, this channel does not grow together and a purulent fistula is formed. Fistulas often form, which directly proves the development of pathological microorganisms inside a person. Any neoplasm is nothing more than a reaction of the body to the development and reproduction of these pathogens. If fistulas are found, you should immediately resort to the help of experienced specialists so that they carry out the necessary diagnostic measures and advised on how to properly treat this disease.

Important! Self-medication is not recommended, it can harm your health.

Causes of the appearance of a ligature fistula

A ligature fistula is formed after a caesarean section for a number of reasons. These are often:

infections entering the body through stitches;
insufficient cut treatment;
violation antiseptic rules during surgical procedures;
the appearance of allergic reactions to special materials used for suturing the wound;
age limits;
the general condition of the woman;
immunity;
the presence of chronic diseases;
the formation of inflammatory processes associated with seasonal diseases;
bad equipment;
consequences after cancer;
a lack of useful minerals in the body;
the presence of diabetes;
excess weight;
metabolic disorder syndrome;
inflammation in the mouth.

Fistulas often appear due to postoperative scars. Unsanitary conditions, enormous physical exertion, stressful situations, use of past-expired patches and bandages, malnutrition and bad habits also favorably affect the development of purulent fistulas. With immediate treatment, further complications can develop that will affect the health and performance of the woman.

Symptoms of a fistula after a caesarean section

Signs of a fistula on the seam after the use of cesarean are the following phenomena:

in the first days there is a sharp compaction of the suture site, its redness. Doctors may observe slight swelling and a slight increase in body temperature;
after 7 days, liquid comes out of the sutures with strong pressure and palpation, and later a purulent connection;
on the 10th day, a feverish state appears, the body temperature increases to 38 °;
fistulous canals are clogged on their own, but when inflammatory processes appear, they open again;
the appearance of a hole in the skin;
hot area around the seam.

Fistulous openings are always accompanied by the appearance of a slight temperature. In the earliest stages, this rise is insignificant, but this condition cannot be ignored, it is better to immediately consult a doctor to start treatment on time. It is very difficult not to notice the fistula, all the symptoms quickly appear, it is quite simple to recognize the neoplasm. Usually, after a cesarean section, the doctor often examines the patient and watches how the stitches heal, so he will very quickly detect infection and the development of inflammatory foci.

Treatment of ligature fistula

Before starting treatment, every woman should understand that getting rid of the ligature fistula is possible only with the help of surgery. Prolonged delay in treatment can lead to a number of complications. Treatment includes taking the following medications:

Antiseptic agents with a local anesthetic effect.
ampicillin groups.
Enzymes that are soon able to dissolve dead cells.

These medicines must be introduced into the fistulous canal and peripheral places with a certain frequency, because their effect lasts for 5 hours.

It's important to know, which at strong discharge purulent fluid from the fistula is forbidden to treat the incision with fatty ointments, because they clog the canal passage, which contributes to the further spread of the infection.

With a strong inflammatory process, you can resort to other methods of treatment - physiotherapy procedures. Experienced Professionals Recommend quartz wound. The procedure helps to reduce swelling and improve the patient's condition. But such measures can only stop the development of the disease, cure it completely - in no case. Only with the help of surgery can you get rid of the cause of constant suppuration. This disease cannot be treated at home.

Attention! Before taking any medications, consult your doctor!

Preventive actions

Doctors cannot guarantee 100% safety during and after surgery. Many infections penetrate quickly and deftly, so there are no exact preventive measures. But experts advise to adhere to the following rules:

it is necessary to abandon the use of thick silk threads for stitching the incision;
after a caesarean section, use only synthetic threads;
strictly follow aseptic measures;
for speedy healing, take the drugs prescribed by the doctor.

In order to prevent the appearance of a fistula, you should properly care for the sutures, make dressings on time, take medicines, healthy lifestyle life and eat right. Any deviations from the norm can provoke the development of pathology, even the appearance of diseases that are in no way related to gynecology and urinary system: problems with the heart vessels, with the system gastrointestinal tract and mucous membranes.

What do doctors think

No doctor can fully guarantee that the operation will not entail adverse effects. Ligature fistulas appear due to the penetration of infectious microorganisms into the incision. Experts recommend that the pathology be dealt with immediately, because it can provoke the development of further complications and lead to sepsis. Therefore, it is imperative to consult a doctor for fistulas after a caesarean section. It is very easy to detect it, doctors advise paying attention if a seal appears around the wound and infiltrate.

All seals become hot, because this is due to the course of the infectious process. Near the scar, redness will always be visible, at first small, then huge. During surgical interventions, the wound often fester, all the contents come out of it. It is also necessary to monitor the fact that these processes can provoke the appearance of swelling of peripheral tissues. Experts recommend not to be silent about the development of fistulas, because they require immediate treatment. Surgeons may decide to operate again in order to completely cure the woman. To do this, they will use only thin surgical threads made of synthetics.

Conclusion

Fistula after caesarean section mandatory treatment. The patient is obliged to contact a specialist in time so that he can prescribe a number of necessary examinations and tests. Only an experienced specialist can prescribe treatment, all preventive and diagnostic measures are carried out only in a hospital. Treatment is conservative and surgical. Most often, fistulas get rid of surgically, after the woman is prescribed antibiotics. Wounds always require special care. For this, compounds are purchased, they help to clean the wound from purulent fluid and avoid subsequent infection. Doctors recommend the use of hydrogen peroxide and furacilin.

Conservative therapy helps when the process of fistula development has just begun. Doctors are trying to remove dead tissue around the inflammatory focus that has appeared, to wash out the pus completely. Often those threads that come out and provoke the growth of fistulas are removed. After getting rid of pathology The patient is prescribed a course of antibiotic therapy and taking complex vitamins.

To avoid a ligature fistula, it is important to properly lubricate the wound, both before and after suturing. Doctors are required to work only with sterile materials. When the first signs of pathology appear, they should provide timely medical care. In most cases, the outcome of the disease is favorable.

Any surgical intervention serious challenge for the human, requiring strength and time for full recovery. That is why it is very important that there are no complications after the operation. Unfortunately, fistulas often occur in operated patients. What is it and how to deal with them?

Description

A fistula (also known as a "fistula") is fairly easy to recognize: it's actually a hole in the skin followed by a narrow channel.

A fistula may appear as a result of any pathological process in the body, but most often it occurs after surgery. Fistula is a common complication after surgery (up to 5% of cases), it can occur both a few days after surgery and after several months.

The principle of cleanliness and sterility during surgery.
Before the operation, a mandatory check of the processing of the instruments used suture material(packaging integrity, expiration date).
Thorough washing of the wound before suturing.
Use of high-quality self-absorbable suture materials.
After the operation, the surgeon and other medical staff should also take all measures to prevent postoperative complications, including the appearance of fistulas: regular examination of the patient, dressings, processing and sanitation of the suture.
In addition, the doctor should always inform the patient about possible postoperative complications, their symptoms, the need and importance of timely treatment for help.

The implementation of measures to prevent complications after surgical interventions, including fistulas, significantly reduces the risk of their occurrence.

While watching the video, you will learn about what a fistula is.

Fistula is an unpleasant complication after the operation. Its appearance requires immediate medical attention. The fistula speaks of an inflammatory process in the body, suppuration of the suture material. Treatment of postoperative fistula is to remove the purulent area and affected tissues.

A fistula is a pathological channel that connects a hollow organ and the external environment or two hollow organs. Most often appearsfistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor's instructions.

The fistula is a hollow neoplasm, which in its own way appearance looks like a deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

labial. In this case, fusion of fistulas and skin is observed, as well as muscle tissue. Removal of fistulas is carried out using a surgical method.
Complete. It is characterized by the presence of two outputs, which makes it possible to maximize effective fight with an inflammatory process.
tubular. It is a fully formed channel from which it is observed constant allocation feces, pus and mucus.
Incomplete. The neoplasm is characterized by one exit, the location of which is the abdominal cavity. With this type of fistula, pathogenic microflora multiplies, and inflammation also aggravates.
Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are often observed.

About, what is a fistula after surgeryonly the doctor knows. After an appropriate diagnosis, a specialist will be able to determine the type of formation, which will positively affect the treatment process.

Reasons for the appearance

Postoperative fistulasmay develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After a surgical intervention, the human body may reject the thread, which is explained by intolerance to its components. Against this background, it appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

High immune reactivity of the organism;
Elderly age;
Chronic specific infection;
hospital infection;
Oncological diseases.

If vitamins and minerals enter the human body in insufficient quantities, this leads to the formation of fistulas.. Postoperative fistula, treatmentwhich is very long, appears when there is a metabolic disorder - diabetes mellitus, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy of pathology should be directed to its elimination.

Symptoms

Fistulas after surgerycharacterized by the presence of certain features. Initially, the appearance of a seal on the skin around the size is observed. There is pain on palpation. In some patients, the appearance of pronounced tubercles is diagnosed, which is used to secrete the infiltrate. Reddening of the skin may be observed at the site of infection of the scar.

The pathological process is often accompanied by a sharp increase in body temperature. This is due to the course of the inflammatory process in the human body. Bring the temperature down to normal impossible. Fistulas are accompanied by a purulent process. At untimely treatment pathology, the size of the abscess increases significantly. In patients, there is a tightening of the fistulous opening for a certain period. This is followed by the development of inflammation.

Fistulas are characterized by the presence of certain signs. When they appear, patients are advised to immediately consult a doctor. Timely treatment diseases will eliminate the possibility of side effects.

Features of therapy

Fistula treatment after surgeryin most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions which eliminates the possibility of infection. Surgery requires the use of local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is introduced into it.

The surgeon removes the fistula with a scalpel. All other actions of specialists are aimed at stopping bleeding. After that, the wound is recommended to be washed with a solution of antiseptic action. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

Treatment postoperative fistulas requires the use of not only surgical intervention, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

Diclofenac;
Nimesila;
Dicloberla.

In order to speed up the healing process of wounds, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use drugs that have vegetable origin, - aloe, sea buckthorn oil etc.

That, how long does it take for a fistula to heal after surgery, directly depends on the characteristics of the passage rehabilitation period. Patients are recommended daily hygiene procedures in the area of the operation. The patient is advised to disinfect the sutures daily with the help of special preparations. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to exclude heavy physical exertion. From long-term work sitting position must be canceled for three months.

How does it appear fistula after surgery, what is itonly the doctor knows. That is why, if neoplasms occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

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

If the reaction of the body to the ligature is unpredictable, a focus of inflammation is formed around the threads, an abscess is formed with purulent fusion of tissues. Generally accepted requirements for the antisepsis of surgical material and operating field prescribe careful processing of the incision before suturing. If pathogenic bacteria get into the wound, it will inevitably develop inflammatory process complicated by the formation of a fistula.

Around the ligature, which tightens the edges of the incision, the tissues are compacted, forming a granuloma. It consists of collagen fibers, suture material, fibroblasts. The introduction of pathogenic bacteria into this tissue causes suppuration. Pus finds a way out, and a through hole, or fistula, is formed. The ligature fistula may be the only one, or pus erupts in several areas surgical suture.

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

Reasons for the appearance

For the appearance of a fistula after a caesarean section, there must be predisposing factors.

Common causes of the formation of a ligature fistula:

Infected suture material;

Infection of the surgical field;

Low quality ligature;

Violation of the rules of antisepsis during and after the operation;

Incorrect processing of the surgical suture;

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

The danger of education

When a fistula is formed on the seam left after a caesarean section, it is required 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 the products of tissue decay and the vital activity of pathogenic bacteria. With a rupture of the fistula, 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 - the reaction of the body to the formation of a purulent focus and the accompanying high temperature, negatively affects the functioning of most organs;

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

Organ prolapse abdominal cavity from a melted wound.

Complications can only be prevented timely diagnosis ligature fistula.

Symptoms

Women who have undergone a caesarean section should be aware of the main symptoms of the onset of pathology, because a ligature fistula can form several months after the operation.

More heat skin around the seam compared to the rest of the body;

The separation of pus, ichor from the seam, 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 an early stage of the onset of complications, temperature values \u200b\u200bmay be close to normal, but still increase. The more the inflammatory process develops, the more pronounced hyperthermia.

Diagnostics

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

Palpation of granulated tissues;

Studying the anamnesis, complaints of the patient;

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

Ultrasound with contrast;

X-ray examination with introduction contrast agent.

Treatment

It is categorically 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 under conditions surgical hospital it is possible to prevent the spread of infection, open suppuration and remove the fistula.

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Surgical treatment

There are two tactics surgical treatment ligature fistula - the doctor removes the thread that caused the inflammation, or excised the entire fistula, which is preferable in many cases. The thread is removed blindly through a small incision in the seam area. Suppuration is freed from ichor and pus, washed with an antiseptic solution. If it was possible to completely get rid of the cause of inflammation, the fistula is finally tightened. If there are recurrences, the operation is repeated.

A wide incision is not made, because there is a risk of cellulitis and the spread of infection to healthy tissue. The surgeon may decide not to make an incision, but to remove the ligature from the fistulous canal with a special instrument. After performing the manipulation, the wound is treated with antiseptic preparations, the bandage is regularly changed on it.

In modern clinics, the procedure is carried out under the control of ultrasound scanning, which allows you to accurately determine the localization of the ligature that caused inflammation.

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

Conservative treatments

In the case when the inflammatory process has not yet gone too far, it is possible to use drug therapy. It consists in treating the inflamed area with antibacterial and antiseptic solutions. The purpose of the treatment is the destruction of pathogenic bacteria in the entire area of the wound. Treatments are often carried out to effectively remove pus and disinfect the suture site.

If in this way it is possible to stop the inflammation, the ligature fistula may be delayed spontaneously. To support immunity, immunostimulants and vitamin complexes are prescribed. A course of antibiotics will help keep the infection from spreading. When defensive forces the body will increase, the focus of inflammation will decrease or disappear altogether.

With this method of treatment, there is always a risk of recurrence, 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 observance of the rules of antisepsis during cesarean section, there is a risk of a ligature fistula. It is impossible to predict in advance whether a woman will experience a rejection of the suture material or not. However, preventive measures can help prevent complications.

Rational management of caesarean section;

Compliance with the rules of antiseptics;

Careful preparation of the operating field;

Use of modern surgical materials.

To prevent the development of inflammation of the seam after 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 with external environment or with each other. Another fistula is 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, a.

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. On it, serous or purulent exudate is discharged from the focus of inflammation. You can see the fistula in the place of the projection of the tooth, in its upper part. It looks like a hot spot.

Pararectal fistula occurs as a result of a violation metabolic processes in the tissue around the ampulla of the rectum. Most often, these are the consequences of paraproctitis, or proctitis, a symptom of which is an abscess of fiber. Its main manifestations are purulent or bloody issues, pain, itching, irritation of the epidermis of the anal area.

The information on this site is for informational purposes only and does not self-treatment, a doctor's consultation is required!

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

Complications arising after surgery, ligature fistulas, are dangerous for the patient, as they become a source of infection and can cause severe intoxication of the body.

Causes of ligature fistula after surgery

Any surgical intervention is completed with postoperative treatment, which consists in suturing, performed with a ligature, a special surgical thread, absorbable or non-absorbable.

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

However, there are situations when different kind complications that cause the development of an inflammatory process in the area of the suture, ligature fistulas. This phenomenon has an infectious-allergic nature of rejection and rejection of material alien to the body.

Ligature fistula after surgery may develop:

In an infected state, the ligature itself
In case of non-compliance or violation of the rules of asepsis during the operation
When the ligature is infected with the contents of the wound
With imperfect processing of the postoperative site and the penetration of infection into the suture area

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

The formation of ligature fistulas is characterized by:

Diverse localization in the postoperative area, in any tissue layer
deferred temporary manifestations, from several days, weeks, months, years after suturing
Various degrees of severity of the inflammatory process - from a local area with rejection of the suture material and healing of the fistula to long non-healing inflamed areas throughout the suture
Independence from 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, causing intoxication of the body, which can lead the patient to disability

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

Visually, the vaginal-rectal fistula is presented in this video.

Symptoms and Diagnosis

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

The 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 is not palpable on palpation.
As a rule, the size of the inflamed area has a limited size.
The formation of compacted areas may be accompanied by painful sensations
The formation of a hole, a fistulous canal, on the reddened compacted area, through which the purulent contents are separated, abundant or insignificant
In some cases, in the opening of the fistulous passage, you can see the end of the ligature, larger or smaller in size
The fistulous canal can close, after some time open again
Complete closure of the fistula opening occurs after removal of the infected ligature.

The formation of a ligature fistula may 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 the surgeon.

Diagnostics:

Examination of the patient, assessment of the inflamed area and fistulous canal, palpation of the granuloma
Analysis of patient complaints, study of his medical history, data on surgical operations
Probing the fistulous canal and assessing its depth
holding various methods studies of the fistulous canal using dyes, x-rays, ultrasonic methods analysis

You should consult a doctor as soon as possible in case of the appearance of the listed symptoms, do not make independent attempts to treat the wound or remove the ligature from the fistulous canal.

Timely diagnosis of a ligature fistula will allow you to immediately begin its treatment.

Ligature fistula: treatment

Fistula treatment is carried out in without fail in conditions medical institution a qualified surgeon. Self-treatment and treatment of the inflamed area in non-sterile conditions are fraught with additional infection and complication of the condition.

Waiting for the exit of the thread and the breakthrough of pus without medical intervention is also dangerous, since it can lead to the development of phlegmon, suppuration of neighboring areas.

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

During conservative treatment measures are taken to eliminate the infection in the inflamed area, as a result, the opening of the fistula is closed.

To treat the site of the fistula, antiseptics are used, antibacterial drugs, solutions of bactericidal indiscriminate action.

Treatment is accompanied by the appointment of antibiotics, anti-inflammatory medicines, drugs-immunomodulators, vitamins.

Unfortunately, cases of re-opening of the fistula are not uncommon if the ligature remains unremoved.

Methods of surgical treatment are aimed at removing the infected non-absorbable suture material from the fistula.

It is removed as follows:

Under operating conditions, the surgeon cuts the tissue in the area of the fistula in order to release pus
Cleansing and washing the wound
Steps are taken to blindly remove the suture
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.
The expansion of the dissection zone is fraught with infection and its spread to neighboring areas
Sometimes attempts are made to remove the ligature using special surgical instruments without tissue dissection, through the fistulous canal
And in case of successful removal of the thread, and in case of failure, the wound is treated with antiseptic preparations; the wound is bandaged; treatment is carried out for the required period while monitoring the condition of the wound

Methods have been developed to remove the thread, carried out 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.

In the presence of several fistulas throughout postoperative suture an operation is performed to excise the affected area with the removal of the ligature.

Necessary condition effective treatment ligature fistula is the complete awareness of the patient about the steps taken and the processing methods used.

Prevention

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

Prevention measures:

Strict observance of the principles of asepsis and antisepsis
Checking the suture material prior to its use - the tightness of the package, expiration date, confirmation of sterility
Thorough wound preparation with antiseptic treatment before suturing
The use of modern suture materials at the final stage of surgical intervention; avoiding the use of non-absorbable silk sutures whenever possible

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

Patient awareness of possible complications after surgery will allow timely detection of their symptoms in case of occurrence 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 the abdominal 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 taking place in the body.

Causes of fistulas after surgery

If, during a surgical intervention, the body has got foreign body, which caused 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 channel. The occurrence of an inflammatory process may be due to the difficulty in the exit of purulent masses due to the narrowness of the channel, the presence in the drainage fluid of the products of the work 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 getting into open wound infections.

A foreign body that has entered the human body begins to be rejected. As a result, the immune system is weakened, 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. These cases include gunshot wounds, closed fractures and other body injuries. Ligature fistulas occur when the body rejects the threads that fasten the edges of the wound.

The appearance of a fistula on the seam can occur both in the first days after the operation, and many years later. It depends on the severity of the inflammatory process and the depth of tissue incision. The fistula can be both external (coming to the surface and in contact with the external environment) and internal (the fistula channel goes into the cavity of the organ).

Postoperative fistula can be created artificially. He is introduced into digestive system for artificial nutrition patient. Artificial fistula of the rectum is formed for unhindered removal stool.

Fistulas in the human body can form with various chronic or acute diseases requiring urgent surgical intervention.

If a cyst or abscess occurs in the cavity of an organ, bone or muscle tissue (with the further appearance of a fistulous canal), doctors excise the suture again. If the inflammation is not eliminated, the infection progresses to more severe form and leads to the emergence of new fistulas.

Types of postoperative fistulas

A ligature fistula is formed after the application of non-absorbable sutures and with further suppuration of the sutures. They exist before complete removal surgical threads and are able to not heal enough 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 deterioration general condition organism. Excretion of feces and urine to the outside is accompanied by bad smell, which causes a lot of inconvenience to a person. Bronchial fistulas are a complication of surgery to remove part of the lung. So far, there are no more advanced ways of suturing the bronchi.

Methods of treatment of postoperative fistulas

In the presence of strong immunity and the absence of infection of the operated tissues, the recovery period is completed successfully. However, in some cases, the seam may become inflamed. The resulting ligature fistula is treated surgical methods. When diagnosing ligature fistulas, doctors use methods to determine the location of the foreign body that caused inflammation and the development of the fistula. Such methods include double shots, the method of four points and tangent planes. When the fistula is opened, the foreign body itself and purulent masses are removed through its canal.

With a successful outcome of the treatment, the inflammation is eliminated and the fistula resolves itself. Spontaneously, this process can occur in very rare cases. This usually requires a large number time, the disease may progress to chronic form and give serious complications. The number of fistulas formed depends on the number of infected ligatures and the vital activity of pathogens. Depending on this, the frequency of the periodicity of the exit of purulent masses from the fistulous canal changes. Ligature fistula is treated both medically and surgically.

Conservative treatment is recommended with a minimum number of fistulas and pus secreted from them. The essence of the treatment is the gradual removal of dead tissue that interferes with wound healing and the removal of surgical sutures. In addition, the patient is advised to take drugs that strengthen 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 furacilin solution. This helps to remove purulent discharge, protect the wound from infection and speed up its healing. At inpatient treatment carry out constant ultrasound control, which is considered the most gentle method of treatment.

Surgery is indicated for patients with large quantity fistulas and rather intensive outflow of purulent masses. Also, this method is used when there is a foreign body in the body and 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 fistulous canal, cauterization or removal of granular tissues along the entire canal with a curette. In addition, the surgeon removes the festering suture material.

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

When one of the ligatures becomes inflamed, only part of the suture is excised and removed. After that, the sutures are re-applied.

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

Treatment of a fistula with folk remedies

In the early stages of the disease, treatment with folk methods can be quite effective. Nice results gives treatment with a mixture of vodka and olive oil. The mixture must be used to treat the affected areas. After this procedure, apply cabbage leaf to help draw out pus. The course of treatment lasts several weeks, after which the fistulous canal disappears.

Fistulas on the skin can be cured with a mixture of aloe juice and mummy. Mummy needs to be soaked in warm water, the resulting solution is mixed with aloe juice. This medicine is used in the form of gauze compresses. A good result is also given by compresses with a decoction of St. John's wort. 2 tbsp. spoons of dry grass pour a glass of water and bring to a boil. After that, the broth is filtered and used for compresses. For treatment, you can also use fresh leaves of St. John's wort. They are placed on a film that is applied to the affected area. The course of treatment lasts until the wound is completely healed.

Fistula of the rectum can also be cured by folk methods. Mix a small amount of toadflax flowers, water pepper leaves and oak bark. The mixture must be cooked over low heat in an oven. The finished ointment with a cotton swab lubricates the affected areas. The course of treatment lasts about 3 weeks. The same method can be used in the treatment of vaginal fistulas. Such an 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 is looking for a way out. This is especially true after surgery. Consider why this happens and how a fistula that appears after surgery is treated.

Fistula - what is it?

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

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

Types of fistulas

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

The fistula may be complete or incomplete. The full one has two holes and is treated faster, as it has a way out, while the incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labial or tubular. The labioform is treated only with the help of surgery.

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

What are the causes of a fistula after surgery?

There are several reasons for this phenomenon:

The source of infection has not been completely eradicated.
With a chronic protracted inflammatory process.
Like the consequences of the blind gunshot wound. Small particles in the body, fragments are perceived by the body as a foreign body, and the process of suppuration begins.
Denial by the body 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.
The reaction of the body to a foreign body.

The fistula on the seam after the operation forms a seal from the suture 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 seam in the infected area there is a thickening, redness, bumps, and here the body temperature is much higher.
As a rule, on initial stage not the entire area of the postoperative suture is inflamed.
There are purulent discharges. The rarer, the more of them.
The affected area is red, swollen and painful to the touch.
The suture site becomes red.
The general condition of the patient may worsen, the body temperature rises to 38 degrees and above.

If you have these symptoms, you need to see a doctor urgently, otherwise infectious process may spread to organs or cause blood poisoning.

Fistula Diagnosis

It is not difficult to diagnose a fistula after surgery, since it can be seen visually if it is external. The doctor, after listening to the patient, examining, pays attention primarily to:

Quantity and quality of secretions.
On 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 fistulous 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 will show the presence of hydrochloric acid, and urinary - the presence of uric acid salts.

It happens that the seam may begin to fester after a long time after the operation, so you need to find out the cause of this phenomenon.

If a fistula still appears after surgery, how to treat it?

Fistula treatment

For successful therapy, first of all, it is necessary:

Eliminate the source of the inflammatory process. If it is a thread, then it is removed.
The doctor should conduct an examination, make a fistulography. This will show if 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 vitamin complex to have more strength to fight germs.
The wound is washed with a syringe with hydrogen peroxide or a solution of furacilin, as these agents perfectly disinfect 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 granulations are removed, and cauterization of the sites is possible.

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

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

Postoperative intervention

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

After rectal fistula surgery, the doctor usually prescribes a diet so that the wound heals faster. After such operations, it is necessary to prescribe painkillers and antibiotics. The wound heals within a month, any physical activity is excluded.

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

Folk methods of treatment

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

It is necessary to take vodka and olive oil in equal proportions. Wet the bandage with this mixture and apply to the inflamed area. Apply a cabbage leaf at night. Such procedures require at least ten.
Well draws pus from the wound a mixture of aloe juice and mummy. Shilajit is diluted with water to the consistency of strong tea. The bandage must be left for a long time.
It is advised to wash the wounds with a decoction of St. John's wort. You can put a bandage on top, and then wrap it with oilcloth. If the solution is hot, then the effect of it 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 amounts of flower honey, pine resin, medical tar, butter, the pulp of an aloe leaf, mix the ingredients and heat in a water bath. Dilute with vodka to desired consistency. Apply ointment around the fistula, then cover with polyethylene 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, put in a glass dish and pour liquid honey so as to completely cover. Stir every day, and insist 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 take place under the supervision of doctors, and folk remedies This is an addition to the main course.

Fistula Prevention

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

First of all, observe the rules of asepsis during the operation.
All instruments and suture material must be sterile.
It is necessary to carry out the treatment of the wound before sewing it up.
Alloying of vessels should occur with a small capture of tissues.
Prescribe antibiotics to prevent infections.
Everything needs to be treated infectious diseases preventing the development of fistulas.

overlay surgical sutures – last stage performing an intravenous operation. The only exceptions are operations on festering wounds where it is necessary to ensure the outflow of contents and reduce inflammation on the surrounding tissues.

Sutures are natural and synthetic, absorbable and non-absorbable. A pronounced inflammatory process at the suture site can lead to the release of pus from the incision.

The outflow of serous fluid, thickening and swelling of tissues indicates such a pathological phenomenon as a ligature fistula of a postoperative scar.

Why does a ligature fistula appear after the operation

A ligature is a thread for tying blood vessels. By applying a suture, doctors seek to stop bleeding and prevent its occurrence in the future. Ligature fistula is an inflammatory process at the site of wound stitching.

It develops due to the use of material contaminated with pathogens. The pathological element is surrounded by a granuloma - a seal that consists of different tissues and cells:

The ligature thread is also part of the granuloma. Its suppuration is dangerous for the development of an abscess.

It is clear that the main reason for the formation of a ligature fistula lies in the infection of the suture material. The development of an unfavorable process is provoked by various factors:

Avitaminosis.
Syphilis.
Tuberculosis.
General condition and age of the patient.
Hospital infection (streptococcus, staphylococcus aureus).
Oncological diseases involving protein depletion.
High immune reactivity of a young organism.
Rejection of the thread by the body due to individual intolerance to the material.
Wound infection due to lack of antiseptic treatment.
Metabolic disease ( diabetes, obesity).
Localization of the operated area (belly in women after caesarean section, paraproctitis).

Ligature fistulas occur in any part of the body and in all types of tissues. As for the time of their appearance, there are no exact forecasts here. In some patients, the problem occurs after a week or a month, but it also happens that the fistula bothers a year after the operation.

Symptoms of a ligature fistula

The following symptoms help to identify a fistula on a scar after surgery:

In the first days after the operation, the area thickens, swells, and causes pain when palpated. The skin surrounding the wound turns red, the local temperature rises.
A week later, when pressing on the seam, serous fluid and pus are released.
Body temperature rises to 37.5 - 39°C.
The behavior of the fistula is unpredictable - the passage can spontaneously close and reopen later.

Completely getting rid of the channel helps only reoperation. What a ligature fistula looks like can be seen in the photo.

Outwardly, it is a deep wound with inflamed skin around the edges. Interestingly, the fistula can form completely different from where the incision was made. Physicians are aware of cases when inflammation developed for a long time inside the patient's body, but the person himself understood that he was sick only when a small hole appeared on the body, from which purulent-serous fluid oozed.

A fistula is a hollow channel inside the body, a kind of link between organs and the external environment. It can also be an articulation internal cavity and oncological neoplasm. The channel, which looks like a tube, is lined with epithelium from the inside. Pus comes out through it. In advanced cases, bile, urine, feces come out of the fistula.

Postoperative fistulas are divided into several types:

Full. Features two outlets. This structure promotes rapid healing.
Incomplete. The fistula has one outlet inside the abdominal cavity. In such conditions, the pathogenic flora multiplies rapidly and enhances the inflammatory process.
Tubular. A properly designed canal releases purulent, mucous and fecal masses.
labial. The fistula fuses with muscle and dermal tissue. It can only be removed by surgery.
Granulating. The fistula is overgrown with granulation tissue, the surface of the surrounding skin looks hyperemic and edematous.

In the ICD-10, the ligature fistula is listed under the code L98.8.0.

Most often, ligature fistulas are formed at the places where the silk thread is applied. To avoid this problem modern doctors use a material that does not require the removal of sutures and through a short time dissolves on its own.

Diagnosis and treatment of ligature fistula on the scar

Ligature fistula is diagnosed during the examination of the postoperative wound. For a complete study of the suspicious area, the patient is sent for ultrasound and fistulography. This is a kind of x-ray with the use of a contrast agent. The picture clearly shows the location of the fistulous canal.

Treatment of a ligature fistula involves A complex approach. Patients are prescribed different groups of drugs:

Enzymes chymotrypsin and trypsin.
Antiseptics for local treatment.
Antibiotics SSD - Norfloxacin, Ampicillin, Ceftriaxone, Levofloxacin.
Water-soluble ointments - Levomekol, Levosin, Trimistin.
Fine powders - Baneocin, Gentaxan, Tyrozur.

Enzymes and antiseptics are injected into the fistulous canal and surrounding tissues. Substances act within 3 - 4 hours, therefore problem area processed several times a day. With abundant expiration of purulent masses, it is forbidden to use Vishnevsky's liniment and synthomycin ointment. They clog the channel and delay the outflow of pus.

In order to relieve inflammation, the patient is sent to physiotherapy. Wound quartzing and UHF therapy improve blood and lymph microcirculation, reduce swelling and neutralize pathogenic flora. The procedures provide a stable remission, but do not contribute to a complete recovery.

Complications of a ligature fistula: abscess, phlegmon, sepsis, toxic-resorptive fever and eventration - prolapse of organs due to purulent fusion of tissues.

Non-closing ligature fistula is treated by surgical treatment complicated postoperative wound. The site is disinfected, anesthetized and dissected to completely remove the suture material. The cause of the fistula is also excised along with adjacent tissues.

To stop the bleeding, an electrocoagulator or hydrogen peroxide (3%) is used, otherwise the flashing of the vessel will provoke the formation of a new fistula. The surgeon's work is completed by washing the wound with an antiseptic (Chlorhexidine, Decasan or 70% alcohol), applying secondary seam and organization of drainage in the treated area.

AT postoperative period the drainage is washed and the dressing is changed. With multiple purulent leakage, antibiotics are used, Diclofenac, Nimesil and ointments - methyluracil or Troxevasin. Minimally invasive methods of fistula removal, for example, through ultrasound, are ineffective.