ICD code 10 purulent lactational mastitis. Mastitis in newborns

Despite the significant progress achieved by modern medicine in the treatment and prevention of infections, purulent mastitis continues to be an urgent surgical problem. Long hospital stays, high recurrence rates and the associated need for reoperations, cases of severe sepsis, and poor cosmetic outcomes continue to accompany this common pathology.

ICD-10 code

N61 Inflammatory diseases of the mammary gland

Causes of purulent mastitis

Lactational purulent mastitis occurs in 3.5-6.0% of women in labor. In more than half of women, it occurs in the first three weeks after childbirth. Purulent mastitis is preceded by lactostasis. If the latter is not resolved within 3-5 days, then one of the clinical forms develops.

The bacteriological picture of lactational purulent mastitis has been studied quite well. In 93.3-95.0% of cases, it is caused by Staphylococcus aureus, which is detected in monoculture.

Non-lactational purulent mastitis occurs 4 times less often than lactational. Its cause is:

• breast trauma;
• acute purulent-inflammatory and allergic diseases of the skin and subcutaneous tissue of the mammary gland (furuncle, carbuncle, microbial eczema, etc.);
• fibrocystic mastopathy;
• benign breast tumors (fibroadenoma, intraductal papilloma, etc.);
• malignant neoplasms of the breast;
• implantation of foreign synthetic materials into the gland tissue;
• specific infectious diseases of the mammary gland (actinomycosis, tuberculosis, syphilis, etc.).

The bacteriological picture of non-lactational purulent mastitis is more diverse. In about 20% of cases, bacteria of the family Enterobacteriaceae, P. aeruginosa, as well as non-clostridial anaerobic infection are detected in association with Staphylococcus aureus or enterobacteria.

Among the many classifications of acute purulent mastitis given in the literature, the widespread classification of N. N. Kanshin (1981) deserves the most attention.

I. Acute serous.

II. Acute infiltrative.

III. Abscessing purulent mastitis:

1. Apostematous purulent mastitis:
   • limited,
   • diffuse.
2. Breast abscess:
   • solitary,
   • multi-cavity.
3. Mixed abscessing purulent mastitis.

Symptoms of purulent mastitis

Lactational purulent mastitis begins acutely. Usually it goes through the stages of serous and infiltrative forms. The mammary gland slightly increases in volume, hyperemia of the skin appears above it from barely noticeable to bright. On palpation, a sharply painful infiltrate without clear boundaries is determined, in the center of which a softening center can be detected. The woman's well-being suffers significantly. There is a sharp weakness, sleep disturbance, appetite, fever up to 38-40 ° C, chills. In the clinical analysis of blood, leukocytosis with a neutrophilic shift, an increase in ESR is noted.

Non-lactational purulent mastitis has a more blurred clinic. At the initial stages, the picture is determined by the clinic of the underlying disease, which is joined by purulent inflammation of the breast tissue. Most often, non-lactational purulent mastitis proceeds as a subareolar abscess.

Diagnosis of purulent mastitis

Purulent mastitis is diagnosed on the basis of typical symptoms of the inflammatory process and does not cause difficulties. If there is doubt in the diagnosis, puncture of the mammary gland with a thick needle provides significant assistance, which reveals the localization, depth of purulent destruction, the nature and amount of exudate.

In the most difficult cases for diagnosis (for example, apostematous purulent mastitis), ultrasound of the mammary gland allows us to clarify the stage of the inflammatory process and the presence of abscess formation. In the course of the study, with a destructive form, a decrease in the echogenicity of the gland tissue is determined with the formation of hypoechoic zones in the places of accumulation of purulent contents, expansion of the milk ducts, tissue infiltration. With non-lactational purulent mastitis, ultrasound helps to identify neoplasms of the mammary gland and other pathologies.

Treatment of purulent mastitis

The choice of surgical approach depends on the location and volume of the affected tissues. With subareolar and central intramammary purulent mastitis, a paraareolar incision is performed. On a small mammary gland, it is possible to produce HOGO from the same access, occupying no more than two quadrants. In the surgical treatment of purulent mastitis, spreading to 1-2 upper or medial quadrants, with an intramammary form of the upper quadrants, a radial incision is made according to Angerer. Access to the lateral quadrants of the mammary gland is made along the outer transitional fold according to Mostkovy. When the focus of inflammation is localized in the lower quadrants, with retromammary and total purulent mastitis, a CHOG incision of the mammary gland is performed with the Hennig access, in addition to an unsatisfactory cosmetic result, the development of Bardengeuer mammoptosis, which runs along the lower transitional fold of the mammary gland, is possible. Gennig's and Rovninsky's accesses are not cosmetic, they have no advantage over the above, therefore, they are practically not used at present.

The surgical treatment of purulent mastitis is based on the principle of CHOGO. The volume of excision of the affected mammary gland tissues is still decided by many surgeons ambiguously. Some authors, for the prevention of deformation and disfigurement of the mammary gland, prefer sparing methods of treatment, which consist in opening and draining a purulent focus from a small incision with minimal or no necrectomy. Others, often noting with such tactics the long-term persistence of symptoms of intoxication, the high need for repeated operations, cases of sepsis associated with insufficient removal of affected tissues and the progression of the process, in our opinion, rightly incline in favor of radical CHO.

Excision of non-viable and infiltrated mammary gland tissues is performed within healthy tissues, until capillary bleeding occurs. With non-lactational purulent mastitis against the background of fibrocystic mastopathy, fibroadenomas perform an intervention according to the type of sectoral resection. In all cases of purulent mastitis, it is necessary to perform a histological examination of the removed tissues to exclude a malignant neoplasm and other diseases of the mammary gland.

In the literature, the question of the use of a primary or primary delayed suture after radical CHO with drainage and flow-aspiration washing of the wound with an abscessing form is widely discussed. Noting the advantages of this method and the reduction in the duration of inpatient treatment associated with its use, one should still note a rather high incidence of wound suppuration, the statistics of which in the literature are generally ignored. According to A.P. Chadaev (2002), the frequency of wound suppuration after the application of a primary suture in a clinic that specifically deals with the treatment of purulent mastitis is at least 8.6%. Despite a small percentage of suppuration, it is still safer for wide clinical use to consider the open method of wound management, followed by the imposition of a primary-delayed or secondary suture. This is due to the fact that clinically it is not always possible to adequately assess the volume of tissue damage by a purulent-inflammatory process and, therefore, to carry out a complete necrectomy. The inevitable formation of secondary necrosis, high seeding of the wound with pathogenic microorganisms increase the risk of recurrence of purulent inflammation after the primary suture is applied. The extensive residual cavity formed after radical HOGO is difficult to eliminate. The exudate or hematoma accumulated in it leads to frequent suppuration of the wound, even in conditions of seemingly adequate drainage. Despite the healing of the breast wound by primary intention, the cosmetic result after surgery with the use of a primary suture usually leaves much to be desired.

Most clinicians adhere to the tactics of two-stage treatment of purulent mastitis. At the first stage, we carry out radical HOGO. The wound is treated openly using water-soluble ointments, iodophor solutions or draining sorbents. With the phenomena of SIRS and with extensive damage to the mammary gland, we prescribe antibiotic therapy (oxacillin 1.0 g 4 times a day intramuscularly or cefazolin 2.0 g 3 times intramuscularly). In non-lactational purulent mastitis, empiric antibiotic therapy includes cefazolin + metronidazole or lincomycin (clindamycin), or amoxiclav in monotherapy.

During postoperative treatment, the surgeon has the ability to control the wound process, directing it in the right direction. Over time, inflammatory changes in the area of ​​the wound are steadfastly stopped, its contamination with microflora is reduced below a critical level, the cavity is partially filled with granulations.

At the second stage, after 5-10 days, we perform skin plasty of the mammary gland wound with local tissues. Given that more than 80% of patients with purulent mastitis are women under 40 years of age, we consider the stage of restorative treatment to be extremely important and necessary to obtain good cosmetic results.

We perform skin plastic surgery according to the J. Zoltan method. The edges of the skin, the walls and the bottom of the wound are excised, giving it, if possible, a wedge-shaped shape convenient for suturing. The wound is drained with a thin through perforated drainage, brought out through counter-openings. The residual cavity is eliminated by applying deep sutures from an absorbable thread on an atraumatic needle. An intradermal suture is applied to the skin. Drainage is connected to a pneumoaspirator. There is no need for constant washing of the wound with the tactics of two-stage treatment, only aspiration of the wound discharge is carried out. Drainage is usually removed on the 3rd day. With lactorrhea, drainage may be in the wound for a longer period. The intradermal suture is removed for 8-10 days.

Skin plasty after the purulent process has subsided can reduce the number of complications to 4.0%. This reduces the degree of deformation of the mammary gland, increases the cosmetic result of the intervention.

Usually, a purulent-inflammatory process affects one mammary gland. Bilateral lactational purulent mastitis is quite rare, only 6% of cases.

In some cases, when the outcome of purulent mastitis is a flat wound of the mammary gland of small size, it is sutured tightly, without the use of drainage.

Treatment of severe forms of purulent non-lactational purulent mastitis occurring with the participation of anaerobic flora, especially in patients with a aggravated history, presents significant difficulties. The development of sepsis against the background of an extensive purulent-necrotic focus leads to high mortality.

MASTITIS honey.
Mastitis is an inflammation of the mammary gland. Dominant age
Mastitis of newborns occurs in the first days of life as a result of infection of hyperplastic glandular elements.
Postpartum mastitis - during breastfeeding
Periductal mastitis (plasmocytic) - more often during menopause.
Predominant sex
Mostly women are affected
Juvenile mastitis - in adolescents of both sexes during puberty.

Classification

Etiology

Risk factors

Pathomorphology

Clinical picture

Laboratory research

Special Studies

Differential Diagnosis

Treatment:

Surgery

Complications

Prevention

Synonyms

ICD

Disease Handbook. 2012 .

See what "MASTITIS" is in other dictionaries:

Mastitis- ICD 10 N61.61. ICD 9 611.0611.0 DiseasesDB ... Wikipedia

MASTITIS- (thorax) inflammation of the mammary gland. Mastitis usually occurs as a result of penetration (through nipple cracks) of pyogenic microbes into the mammary gland. Most often it occurs in lactating women and pregnant women. With mastitis, it suddenly rises ... ... The Concise Encyclopedia of the Household

mastitis- breast Dictionary of Russian synonyms. mastitis n. chest Dictionary of Russian synonyms. Context 5.0 Informatics. 2012. mastitis ... Synonym dictionary

MASTITIS- MASTITIS, breast, mastitis, mammitis, mas tadenitis (from Greek mastos female breast), inflammation of the mammary gland. Distinguish sharp and hron. inflammatory processes. Acute inflammation of the breast can occur at all periods of life, but more often ... ... Big Medical Encyclopedia

mastitis- a, m. mastite mastos breast, nipple. Inflammation of the mammary gland. Krysin 1998. Lex. Michelson 1866: mastitis; BASS 1: suits / t ... Historical Dictionary of Gallicisms of the Russian Language

mastitis- MASTITIS, colloquial. reduced chest ... Dictionary-thesaurus of synonyms of Russian speech

MASTITIS- (from the Greek. mastos nipple chest) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through nipple cracks; occurs more often in the postpartum period ... Big Encyclopedic Dictionary

MASTITIS- MASTITIS, husband. Inflammation of the mammary gland. | adj. venerable, oh, oh. Explanatory dictionary of Ozhegov. S.I. Ozhegov, N.Yu. Shvedova. 1949 1992 ... Explanatory dictionary of Ozhegov

Mastitis- (from the Greek mastos nipple, breast) (breast), an inflammatory disease of the mammary gland in humans and animals, usually as a result of infection through cracked nipples; occurs more often in the postpartum period. … Illustrated Encyclopedic Dictionary

Mastitis- I Mastitis (mastitis; Greek mastos chest + itis; synonymous with breast) inflammation of the parenchyma and interstitial tissue of the mammary gland. There are acute and chronic mastitis. Depending on the functional state of the mammary gland (Mammary gland) (the presence of ... Medical Encyclopedia

MASTITIS- (breast), acute or chronic inflammation of the mammary gland, usually associated with its infection during lactation. MASTITIS IN HUMANS Mastitis, as a rule, occurs in women, although occasionally cystic mastopathy is observed in men. Spicy… … Collier Encyclopedia

Books

• Acute purulent lactational mastitis, A. P. Chadaev, A. A. Zverev. The book covers the issues of etiology and pathogenesis, clinic, prevention and treatment of acute purulent lactational mastitis, as well as the principles of surgical treatment, depending on various forms ...

Postpartum mastitis is an inflammation of the mammary gland that develops after childbirth and is associated with lactation.

ICD-10 CODE
O91 Breast infections associated with childbearing.

EPIDEMIOLOGY

Postpartum mastitis is diagnosed in 2–11% of lactating women, but the accuracy of these figures is doubtful, since some experts include lactostasis here, and a significant number of patients simply do not go to doctors.

CLASSIFICATION OF MASTITIS

There is no single classification of postpartum mastitis. Some domestic experts propose to divide postpartum mastitis into serous, infiltrative and purulent, as well as into interstitial, parenchymal and retromammary.

In international practice, there are 2 forms of mastitis:
Epidemic - developing in a hospital;
endemic - developing 2–3 weeks after delivery in an outpatient setting.

ETIOLOGY (CAUSES) OF MASTITIS AFTER BIRTH

In the vast majority of cases (60–80%), the causative agent of postpartum mastitis is S. aureus.
Other microorganisms are found much less frequently: streptococci of groups A and B, E. coli, Bacteroides spp. With the development of an abscess, anaerobic microflora is somewhat more often isolated, although in this situation staphylococci dominate.

PATHOGENESIS

Entrance gates for infection most often become nipple cracks, intracanalicular penetration of pathogenic flora is possible during feeding or pumping milk.

Predisposing factors:
lactostasis;
Structural changes in the mammary glands (mastopathy, cicatricial changes, etc.);
Violations of hygiene and breastfeeding rules.

CLINICAL PICTURE (SYMPTOMS) OF POSTPARTUM MASTITIS

The clinical picture is characterized by local soreness, hyperemia and compaction of the mammary glands against the background of an increase in body temperature. A purulent discharge from the nipple may appear.

DIAGNOSTICS

Diagnosis is based primarily on the assessment of clinical symptoms. Laboratory methods are not accurate enough and are of an auxiliary nature.

CRITERIA FOR DIAGNOSIS

Fever, body temperature >37.8 °C, chills.
Local pain, hyperemia, induration and swelling of the mammary glands.
Purulent discharge from the nipple.
Leukocytes in milk> 106/ml.
Bacteria in milk >103 cfu/ml.

Acute mastitis can develop during any period of lactation, but most often it occurs in the first month after childbirth.

ANAMNESIS

Lactostasis and nipple cracks are the main predisposing factors for mastitis.

PHYSICAL EXAMINATION

It is necessary to examine and palpate the mammary glands.

LABORATORY RESEARCH

·Clinical blood test.
· Microbiological and cytological examination of milk.

INSTRUMENTAL RESEARCH METHODS

Ultrasound of the mammary glands allows you to identify foci of abscess formation in most cases.

SCREENING

All puerperas need to examine and palpate the mammary glands.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis between lactostasis and acute mastitis is quite complicated. An indirect confirmation of mastitis is the unilateral nature of the lesion of the mammary glands.

It may be necessary to consult a specialist in ultrasound diagnostics and a mammologist.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Ten days after natural childbirth. Left side mastitis.

TREATMENT OF MASTITIS AFTER BIRTH

GOALS OF TREATMENT

Stop the main symptoms of the disease.

INDICATIONS FOR HOSPITALIZATION

Abscessing of mammary glands.
The need for surgical intervention.

NON-DRUG TREATMENT

In addition to antibiotic therapy, additional pumping of the mammary glands is carried out, cold is applied locally (many authors, including foreign ones, recommend heat compresses).

MEDICAL TREATMENT

The basis of the treatment of acute mastitis is antibiotic therapy, which must be started immediately (within 24 hours) after the diagnosis is established.

Recommended regimens for oral antibiotic therapy:
Amoxicillin + clavulanic acid (625 mg 3 times a day or 1000 mg 2 times a day);
oxacillin (500 mg 4 times a day);
Cephalexin (500 mg 4 times a day).

The duration of treatment is 5-10 days. Therapy can be completed 24-48 hours after the disappearance of the symptoms of the disease. If methicillin-resistant S. aureus is found, vancomycin is given.

In the absence of signs of clinical improvement within 48-72 hours from the start of therapy, it is necessary to clarify the diagnosis to exclude abscess formation.

Despite ongoing treatment, breast abscesses form in 4–10% of cases of acute mastitis. This requires mandatory surgical treatment (opening and drainage of the abscess) and transfer of the patient to parenteral antibiotic therapy. Given the significant role of anaerobes in the etiological structure of breast abscesses, it is advisable to start empirical therapy with parenteral administration of amoxicillin with sclavulanic acid, effective against both aerobic and anaerobic microflora.

To suppress lactation during abscess formation, cabergoline (0.5 mg orally 2 times a day for 1-2 days), or bromocriptine (2.5 mg orally 2 times a day for 14 days) is used.

SURGERY

Breast abscesses are opened and drained under general anesthesia.

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

Consultation of the surgeon is necessary for abscessing of the mammary glands.

APPROXIMATE TIMES OF INABILITY TO WORK

Postpartum mastitis is the basis for granting postpartum leave of 86 calendar days (an additional 16 days).

TREATMENT EFFECTIVENESS ASSESSMENT

Drug treatment is effective if the main symptoms of the disease stop within 48-72 hours from the start of therapy.

PREVENTION OF MASTITIS AFTER BIRTH

Compliance with the rules of breastfeeding.
Prevention of formation of nipple cracks and lactostasis.

INFORMATION FOR THE PATIENT

Women in childbirth should be informed about the need to immediately consult a doctor with an increase in body temperature, the appearance of local pain and compaction of the mammary glands.

FORECAST

The prognosis is favorable. With inadequate therapy, generalization of infection and the development of sepsis are possible.

Inflammation in the mammary gland due to milk stasis. A factor predisposing to the development of mastitis are nipple cracks.

Laser therapy for lactational mastitis is carried out to eliminate lactostasis and local inflammation. The tactics of treatment is determined by the form of the disease: with serous mastitis, direct laser irradiation of the mammary gland is permissible; in the presence of purulent complications accompanied by intoxication, fever and the presence of pus in the milk expressed from the affected mammary gland, direct laser irradiation is recommended to delimit the purulent process, which facilitates subsequent surgical intervention in the required volume.

In this case, the main therapeutic measures include a parallel effect on the immunocompetent organs and zones: the projection zone of the thymus, blood irradiation according to the supravenous method in the projection of the ulnar and axillary vessels, axillary lymph nodes on the side of the lesion.

As acute inflammatory phenomena decrease: symptoms of intoxication, decrease in temperature to normal or subfebrile values, decrease in tension in the mammary gland, direct laser irradiation of the affected mammary gland is permissible: first in the peripheral sections, and in subsequent sessions - in the projection of the focus of inflammation.

It should be recalled that during the entire period of the disease, milk from the affected mammary gland is expressed and the child is not given, and during antibiotic therapy, the child is transferred to artificial feeding during the entire period of taking antibiotics. In both variants of mastitis, treatment is supplemented by irradiation of receptor zones positioned in the projection of the outer surface of the forearm, the back of the hand, the outer and anterior surface of the lower leg, the anterior chest wall, the paravertebral zones of the spine in the Th1-Th7 projection, and the collar zone.

It should be especially noted that laser irradiation of the mammary gland has a positive effect on the quality of milk and cannot be considered as a reason for restricting the feeding of a child.

Modes of irradiation of medical zones in the treatment of lactational mastitis

Rice. 116. Irradiation zones in the treatment of lactational mastitis. Symbols: pos. "1" - projection of the axillary neurovascular bundle, pos. "2" - ulnar vessels, pos. "3" - projection of the thymus, pos. "4" - the mammary gland, the proposed zone of lactostasis, pos. "5" - zone of segmental innervation of the mammary gland.

The duration of the course of treatment is determined by the positive dynamics. A regularity was noted: the earlier treatment with laser therapy was started, the shorter the course duration. The implementation of treatment from the first day of the disease determines the duration of the course within 3 procedures. At the beginning of the course of treatment on the 3rd day and later, the duration of the course is 8-10 procedures or more.

But this opinion is erroneous, since it can also appear in women who have never given birth to children, as well as in men and even in newborn babies.

What is mastitis (ICD code 10), what it is and what are the causes of the development of the disease - let's talk about it.

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signs

This disease is characterized by inflammation of one, and in some cases both mammary glands.

At the same time, a person experiences pain, the chest becomes heterogeneous, seals appear in it, it roughens, the skin turns red, the body temperature rises, and sometimes unusual discharge (pus) appears.

When the first signs of this disease appear, you should consult a specialist, especially when it comes to a nursing mother. .

It's important to know: you can not continue breastfeeding with a purulent form of mastitis, as this can harm the health of a newborn baby.

Based on the clinical course of the disease, mastitis can be:

1. Acute - a form of the disease in which the inflammatory process affects the breast tissue. In most cases, they suffer from women who have become mothers for the first time, whose children are breastfed;
2. Chronic - a form of the disease observed for a long time, and sometimes for a lifetime. One of its varieties is plasmacytic mastitis, which occurs mainly in older women.

Causes of lactational mastitis:

1. Insufficient expression of milk, resulting in stagnation. Which can be fought with the help of careful decanting with your hands or with a breast pump. Otherwise, such stagnation can lead to the formation of mastitis;
2. The defeat of the mammary glands by infections through wounds and cracks that arose as a result of improper attachment of the child to the breast. A prime example is Staphylococcus aureus.

Doctor's comment: various thyroid diseases, hypertension also contribute to the development of mastitis.

Causes of non-lactational mastitis:

1. Infection of the mammary glands;
2. Impaired health in adults or the perinatal period in newborns.

What is the main purpose of classification

There is an international classification of absolutely all diseases, the main purpose of which is to assign a class and code to each specific human condition.

Knowing him, another doctor, scientist or relative can find out what kind of disease the patient has and draw appropriate conclusions about his health. This document is periodically updated, supplemented and each time a revision number is given.

The number 10 is the number of the last revision, it is they who should be guided by specialists in their practice.

Disease Code

Diseases of the mammary gland are characterized by a disease class from N60 - N64, mastitis corresponds to N 61. Next comes a block of codes from 085 to 092, which describes the main complications that arose after a standard birth.

In accordance with the international classification of diseases of the 10th revision (ICD 10), the following codes correspond to mastitis 091-092:

1. Mastitis, the appearance of which is due to the birth of a child - 091;
   • Purulent - 091.1;
   • Nonpurulent - 091.2.
2. The causes of the disease can be determined by the following code:
   • Sore or fissure of the nipple - 092.1;
   • Violation of unspecified nature 092.2;
   • Violations resulting in initially little or no milk 092.3;
   • Reduced breast milk production 092.4;
   • Lack of milk production or its production in insufficient quantities after normal feeding, sometimes associated with the state of health of the mother 092.5;
   • Disorders associated with excessive milk production, and sometimes the development of lactostasis. Codes 092.6 and 092.7 respectively.

Disease code in children

The block of codes P00-P96 characterizes the condition of newborns. Mastitis in newborns is classified under code P39.0.

It occurs in infants as a result of an increased level of hormones that have passed to them with the mother's blood. Treatment in this case is not required, since the disease resolves within a few weeks from the moment the child is born without the intervention of specialists.

Take note: a child who has this disease is the most vulnerable, so it is necessary to make special demands on cleanliness in the house, as well as to monitor compliance with the hygiene rules of all family members.

Using the codes of this classification of diseases, doctors summarize information from around the world about the number of cases, the most effective ways and methods of providing assistance, as well as an analysis of the patient's condition.

Watch the following video about the features of a disease such as mastitis: