Anaerobic putrid abscess in patients with diabetes
Science Articles / / May 02, 2016
Turutin AD, Olovyanishnikova IV, Vyskubov VN Vyskubov SA, Slobodkin AY, AV Zhuikov
Anaerobic putrid abscess - a rare pathology among the forms of acute abscess (3.2% of cases), but it is characterized by an aggressive, severe, since more often diagnosed in people weakened, exhausted.It is known that in patients with diabetes any acute suppurative disease is accompanied by severe, due to the fact that as a result of an acute inflammatory process is disrupted peripheral glucose uptake is significantly activated by the breakdown of proteins and fats, and dramatically increases the need for insulin.The main reason for the heavy flow anaerobic putrid abscess in patients with diabetes is insulin resistance.The situation may worsen if the diabetes was originally decompensated.
purpose of research - to determine the dependence of the severity of anaerobic putrid abscess on the severity of diabetes.
From 1999 to 2004 in the department of Coloproctology was on the treatment of 19 people with extensive anae
prehospital period flow anaerobic putrid abscess lasted an average of 6.7 days.All the patients were taken to the hospital emergency in critical condition with clinical septic intoxication (tachycardia, fever up to 40 ° C, low blood pressure) and ketoatsidoticheskaya precoma, with intense pain, cyanotic, sometimes with necrosis area in the center of the perianal areaskin.At 9 men inflammatory process spread to the scrotum (abscess Fune), 3 women noted the spread of putrefactive phlegmon on the labia majora and the outer opening of the inguinal canal.All patients received intensive preoperative preparation (6 to 18 hours), - correction of hemodynamic disorders, antibiotic therapy, mandatory translation of patients with type 2 diabetes to insulin.The need for insulin in Type 1 patients compared with domestic insulin dose was increased by 50 - 70%.The need of insulin in patients with type 2 (insulin was administered for the first time) averaged 1.25 - 1 75ED per kg body weight.Most long-term correction and stabilization of blood glucose levels was observed in patients with type 2 diabetes (11 people).
Patients were operated on an emergency basis under intravenous anesthesia.Surgical treatment - a wide dissection, nekroektomiya within healthy tissues and extensive drainage with antiseptic (chlorhexidine frequently used).During surgery performed transfusion 5% glucose at a rate of 100 ml per hour.During the surgical treatment need for administration of insulin does not arise.
Postoperative treatment in the reanimation department (mean 4.8 days).Dressings were made two times per day with 3% hydrogen peroxide and a concentrated solution of potassium permanganate.If necessary, repeat nekroektomiii performed under intravenous anesthesia or incisions carried expansion.We noted that the wider the cut when the emergency operation, the more favorable the wound healing period.Insulin therapy in the postoperative period was carried through Perfusor (rate of introduction of 2-4 units per hour), 6 patients experienced a sharp decrease in insulin requirements as early as the first day after surgery.In 8 patients remained insulin to 3-5 days postoperatively (3 patients with diabetes mellitus type 1 and 5 patients with type 2 diabetes).All patients received intensive antibiotic therapy (intravenous tsefalosparinov the maximum doses metrogil) pitistafilokkokovoy transfusion of plasma, albumin, parenteral nutrition solutions assists and 10% glucose solution.
retrospectively studied history of diabetes mellitus in all patients, it was observed that patients with type 2 diabetes was observed long period of decompensation of diabetes.This is probably due to concomitant diseases (asthma, coronary heart disease, chronic latent pyelonephritis), as well as with the social factor - alcohol abuse, smoking.In patients with type 1 diabetes also often noted decompensation, but the average duration of the period of the disease was not great - 3 - 5 years.
As subsided inflammation and normalization of blood glucose postoperative wound carefully washed and then drained with levomikol and dioksikolem.Diabetics in the majority of cases were discharged to intensive or conventional insulin therapy under the supervision of endocrinologists and Coloproctologists clinics.(The mortality rate of patients with diabetes with anaerobic rotting paraproctitis was 3 (22%) of all patients with type 2 diabetes Causes of death -.. Sepsis, acute heart failure, acute renal failure
Thus, in patients with type 2 diabetes.the most aggressive during anaerobic rotting paraproctitis. The outcome of treatment depends on the compensation and duration of diabetes, presence of comorbidities. The decisive factor in the successful treatment of these patients is emergency surgery with a wide dissection of tissues and nekroektomiey.