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Vaginal foreign body

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[Intro]

Vaginal foreign body is mainly manifested as increased vaginal discharge and infection, failed to remove the long-term retention, can cause urogenital fistula vaginal ulcers, pelvic abscess, stones, and easily lead to misdiagnosis and caused great pain to the patient's mental and physical. vaginal foreign body is not uncommon in clinical practice, vaginal foreign bodies can occur at any age domestic girl common, can also be found in psychiatric adult patients; normal adult women abroad have also occurred.


disease Introduction

Pinyin: yīn dào yì wù
English Reference: vaginal foreign the body
disease code: ICD: T19.2
Classification of Diseases: obstetrics and Gynecology
vaginal foreign body mainly as increased vaginal discharge and infection, long-term stay can not remove, can cause the

vaginal foreign body


urogenital fistula, vaginal ulcer, pelvic abscess, stones, and so on. In clinical practice is not uncommon, can occur at any age, more common domestic girl, can also be found in the mentally ill adult patients; normal adult women abroad have also occurred.
vaginal foreign body mainly as increased vaginal discharge and infection, failed to remove the long-term retention, can cause urogenital fistula, vaginal ulcers, pelvic abscess, stones, and easily lead to misdiagnosis, to patients with mental and The flesh has brought great suffering.

signs and symptoms

(1) pain and bleeding of the

symptoms: large foreign body, irritating foreign body, such as folk "suppository" can cause severe vaginal pain and bleeding, or glass, perfume bottles in the attempt to remove the rupture, damage the vaginal wall, patients presented with chronic pelvic pain or lumbosacral pain. A 75-year-old elderly patients suffering from hemiplegia hospitalization, the patient complained of white with odor and pelvic pain of a 25

vaginal foreign body


years, bimanual and of co-diagnosis examination revealed that the spherical objects in the vagina and its surrounding granular granulation tissue proliferation, spherical object diameter of about 4cm from the vaginal opening about 3 to 4cm, pelvic x-ray examination, then remove the foreign body through the vagina under general anesthesia. The vagina spherical objects may be placed on 25 years ago for the treatment of pelvic tissue relaxation disease.
(2) vaginal discharge with odor: according to the different nature of the foreign body, can cause acute, chronic vaginitis, vaginal itching, vaginal discharge, with the smell; or pus , bloody secretions; or repeated attacks of yellow, thin, and the smell of liquid discharge, secretions long-term irritation or lead to leakage of urine due to complications, can be combined to vulvitis performance genitals or inner thighs, skin rash, following the After infection, the sense of vulvar burning, mobility.
young girls vaginal foreign bodies occur at or within a short time more than any pain, or vaginal itching to tell the mother usually did not pay attention, or due to fear not advertised parents, to be an increase in vaginal discharge or bleeding when parents find and attract attention. Outpatient encounters a girl vaginal discharge, history of vague, should think of the possibility of foreign body, especially inflammatory treatment, did not improve, they should attract attention, can not fully believe that patients denied history of vaginal foreign body rash diagnosis and treatment of .
(3) foreign body sensation in the vagina with sexual pain: foreign body sensation in the sexual life cycle of women may be due to the size of the foreign body during intercourse, and in severe pain during intercourse, long-term foreign bodies caused by scar formation, vaginal atresia , not even sexual intercourse. The Lesy report a 21-year-old complained of pain during intercourse and vaginal stench five women, their vaginal fornix to the formation of scar adhesions, scar depths of a plastic bottle cap for a 3.2cm × 2.2cm.
(4) dysuria, urgency: vaginal foreign body compression bladder or with bladder stones, dysuria, urgency symptoms.
(5) vaginal foreign body caused by a urinary fistula or fecal fistula and other complications in clinical practice, there may be leakage of urine, fecal vaginal discharge or vaginal paroxysmal exhaust phenomenon.

signs

(1) gynecological examination showed mucosal hyperemia of the vulva and vagina skin around the mouth, flushing, and some showed eczematous changes.
(2) vaginal speculum examination the foreign body was found. foreign body in infants and young children have a vaginal foreign body, such as a large foreign body, and hard, can be found in the inspection of the rectal examination, but soft and small, easy to detect, to spy on vaginal examination under general anesthesia, the nose is.
(3) See the vaginal wall flushing, congestion, and even ulceration, typical ulcers in the vaginal fornix, round, irregular margins, at the bottom of the red particles. Ulcer edge newborn epithelial shedding.
(4) the formation of vesico-vaginal fistula and rectovaginal fistula, the vaginal wall visible fistula hole, vagina, urine and faecal contamination, individual patient fistula hole smaller or hidden parts of the check required by the auxiliary confirmed.
(5) long-term chronic inflammation of the vaginal mucosa granulation and the formation of polyps; further development of inflammation and associated with infection, a vaginal stenosis, adhesions, and even vaginal part of the latch.
(6) When the presence of a foreign body, the vagina often mixed flora, such as vaginal Haemophilus, of naphthalene Joseph Neisseria gonorrhoeae, Chlamydia, Mycoplasma, Ureaplasma urealyticum, Trichomonas, etc., through the secretion objects smear or culture can only be diagnosed.

disease etiology

1. vaginal foreign body sources
(1) foreign bodies by others stuffed: such as cotton balls and gauze left over from when the surgery or treatment; for enhanced sexual stimulation, sexual partners, glass, gin bottles, beverage bottles, metal jewelry boxes into the vagina.
(2) self-stuffed: common in infants and young children out of curiosity or to attempt to lift such as vaginal itching, foreign body into the vagina. ding shuzhen reported nine cases of vaginal foreign bodies of infants and young children, ages 3 to 10 years of age, were of normal intelligence, which by the age of the children into the vagina, three cases; two cases of adult mental disorders into the vagina; own stuffed two cases; 2 cases of unknown causes.
2. vaginal foreign body classification strayed into many types of vaginal foreign body: issuing matchstick, peanuts, corn kernels, soybeans, grain, bicycle ball, cigarette filter tip, a small stones, plastic cap, stalk, pins, small mother and buckle, a short plastic rope, glass ampoule, metal perfume bottle and so on. Adults seeking sexual stimulation in the cucumber, oranges, onions, perfume bottles, phallic mold into the vagina, and ultimately can not be removed, or due to negligence contraceptives forgotten in the vagina.

pathophysiology

1. stuffed foreign body for therapeutic purposes, such as gauze left after vaginal surgery for oppression or to stop bleeding; vaginal pessary placed in the treatment of uterine prolapse patients a long time to remove, resulting in changes in vaginal flora and acute inflammation.
2. vaginal foreign body condoms for contraception, diaphragm, cervical cap, etc. left in the vagina.
for abortion or induced abortion folk take the medicine "can have a corrosive effect on the vaginal mucosa, some unwed girls self-abortion, a variety of foreign objects into your vagina.
4. sexual stimulation by the sexual partner or own a variety of foreign objects into the vagina, are more prone to drunken, more common in women of childbearing age also occur in older women. vaginal foreign body of Asrtid Novak reported three cases of older women, one of the 81-year-old to the hospital emergency department because of vaginal pain, then took out a plastic penis-like foreign body from the vagina, she admitted to masturbate 1-2 times a week with the matter ; a glass of the vagina of another 69-year-old woman her husband seven years ago can not be sexual intercourse with a glass substitute, after the couple failed to remove it, and her husband forbade her to a doctor, she come to see a doctor until after the death of her husband, The cut can not be glass was removed and only the fragments one by one remove.
5. foreign body from other parts of the intrusion into the reproductive tract.

diagnostic tests

diagnostic basis

1. foreign body inserted into the vagina a history or suspected history of vaginal foreign body.
2. clinical manifestations of increased vaginal discharge was pus and blood and water samples, with the smell.
3. anal dre probe and vaginal foreign body in the sexual life history of women by vaginal examination

vaginal foreign body check


can make a diagnosis.
4. when necessary for B, X-ray, CT and other examinations.
5. generally no symptoms or signs of systemic infection.
6. reproductive tract local inflammation via secretion smear, culture or PCR, confirmed.
7. children, some small and soft non-metallic foreign body diagnosis more difficult, useful foreign children colposcopy to diagnosis. No children vaginal examination in China special equipment, commonly used in the nose instead.

laboratory tests

1 vaginal discharge smears Find Trichomonas, candida and other pathogenic microorganisms, to determine the type of infection. vaginal foreign body is easy to co-infection, diagnosis and treatment of vaginal secretion smears can help.
2. vaginal cytology to assist in the diagnosis of inflammatory reaction to rule out malignancy, such as infants and young children should be excluded from the grape-like sarcoma of the cervix and vagina.
3. methylene blue test purpose is to identify the vesico-vaginal fistula, cervical-vaginal fistula or ureteral-vaginal fistula, and help to identify the unknown location of a very small fistula hole. method for 200ml diluted methylene blue solution injected into the bladder through the urethra, if you see a blue liquid through the vaginal wall holes overflow vesico-vaginal fistula; blue outflow of liquid through the cervical os for bladder cervix fistula; out of the clear urine in the vagina fluid, the urine from the kidney is a ureter-vaginal fistula. other

auxiliary check

1.X line ray examination according to the nature of foreign body, and sometimes opaque shadow can be seen.
cystoscope check to understand the situation of the bladder, with or without stones, inflammation, in particular, the leak location and number.
vaginal lavage commonly used in young girls or girls douching can not only improve the vaginal environment conducive to the treatment of vaginitis, a small foreign body may be out of the vagina in order to confirm the diagnosis. Summary of the clinical reports of pediatric and adolescent gynecology from the University of Michigan from 1996 to 2000, before puberty, abnormal vaginal discharge, 31 cases, the average age of 6 years of age, vaginal discharge duration of 13 months (1 to 42 months) of which 15 cases need to rule out a vaginal foreign body, accounting for 52%, seven cases of vaginal lavage have found that vaginal foreign body in two cases, 10 patients underwent colposcopic examination was normal, the authors suggest that vaginal lavage can be excluded as a routine method of vaginal foreign bodies.
IVP contrast intravenous injection of 76% diatrizoate at 5,15,30,45 min-ray film in order to understand the function and ureters of both kidneys without exception, for the diagnosis of ureteral-vaginal fistula . differential diagnosis

Differential diagnosis: 1. vaginitis vaginal foreign body secretions increase, with the bacteria, trichomonas and candida vaginitis difference trichomonas vaginal discharge was yellow foamy, candida was rubbish like the main symptoms of genital itching by speculum examination

of vaginal foreign body


vaginal examination can help diagnose infants and young children can be used for DRE, not exploration and vaginal foreign body
2. the cervicitis main performance of the vaginal discharge increased vaginal foreign body to identify the disease is often accompanied by vulvar itching, bladder irritation. Check to see cervical hyperemia and edema, the surface of purulent mucus, and no vaginal foreign body.
3. vaginal pinworm infection girl more common, with severe itching, genital skin, especially around the anus may appear dermatitis and scratches, light vaginal smear inflammation cellophane tape anal test method can be seen pinworm eggs.
4. reproductive system cancer when vaginal discharge foul smell when malignant phase identification, such as cervical cancer, endometrial cancer, vaginal cancer, fallopian tube cancer, ovarian cancer, and so on through vaginal speculum examination, vaginal cytology and biopsy can be diagnostic.
AsrtidNovak reported a 73-year-old man accidentally attempt to remove an olive oil bottle in vagina bottle was broken and then to the hospital, the doctor will remove the debris after further examination revealed that patients with urinary retention of approximately 1200ml vaginal examination the right side of the attachment area can reach a large cystic mass, surgical exploration confirmed borderline ovarian tumors after.

treatment options

vagina is elastic, muscular lumen, the top than the bottom wide, and many rampant vaginal mucosa folds, usually anterior and posterior wall close to, so once the entry of foreign matter the vagina is difficult to fall off on their own,
remove the foreign body to remove the foreign body, with the patient's age and foreign matter the size, location, different shape, a slight difference.
(1) remove the vagina: the older children's finger into the vagina to tick the foreign body or trumpet speculum under direct vision using the clamp tweezers foreign body, adult clip directly in the speculum under direct vision foreign body. The Emge report was successfully retrieved with forceps vaginal foreign body: an orange. Take sharp foreign body should be a foreign body long axis of the vagina the longitudinal axis parallel to the foreign body sharp end toward the mouth of the vagina to prevent damage to mucosal tissue.
(2) over rectal palpation method: the young children in your fingers under the guidance of the rectal examination with a hemostat or small curette into the vagina, foreign body pushed out.
(3) Nose: The nose is to expand early childhood vaginal, forceps tweezers foreign body, young children who can not cooperate feasible ketamine intravenous anesthesia. Nose stems and leaves about 3cm, arrived in the vagina. 1% tetracaine topical anesthesia (tetracaine), the nose is more open vaginal foreign body bureau or oval clamp, and then taking a small curette to remove the foreign body. Easy, do not cause damage, easy to promote the use of the basic hospital.


(4) hysteroscopic

vaginal foreign body under direct vision to remove the foreign body: the nose is shorter, nor light, it is sometimes difficult to achieve diagnosis and treatment purposes, useful hysteroscopic take young girls reports of vaginal foreign body: intraoperative local mucosal anesthesia with 1% tetracaine (tetracaine) a piece of cotton at the vaginal orifice sticking 5min before microscopy. Take the bladder lithotomy position, routine disinfection of the vulva, 5% glucose solution 500ml by adding gentamicin 160,000 U wash the vulva. hysteroscopy coated with lubricant slowly inserted into the vagina, and then to the left thumb, showing means the holder of the vulva in cotton balls and oppression, to prevent the liquid outflow, make vaginal swelling, pathological changes in comprehensive observation of the direct vision of the hysteroscopy, according to the condition necessary treatment, such as foreign body, take a biopsy, washing and applicator and so on.
(5) microscopy colposcopy: parker in the 2000 report with a small diameter trocar sheath plus 2 ~ 3mm endoscopy, and normal saline for uterine distention fluid, peep the entire cervical and vaginal found that small foreign objects such as crayons, etc., can be treated under direct vision for vaginal disease diagnosis and treatment of pre-adolescent children, simple operation, small damage, easy to accept.
(6) vaginal lavage: can be catheter inserted into the vagina, with 40% the lithospermum oil repeatedly pressurized wash the vagina, and sometimes a small foreign body, such as gravel, grain, etc. can be flushing fluid out of the and anti-inflammatory effect.shall be performed after the removal of foreign body
2. local treatment vaginitis to conventional treatment with 0.5% ~ l The% of acetic acid solution vaginal wash, or 1/5000 potassium permanganate solution to wash the vagina, or 5% iodine V scrub the vagina, or partially coated erythromycin ointment. suspicious leech drill into the vagina, often only see the vaginal mucosa congestion and bleeding, partial coated erythromycin ointment, oral anti-inflammatory drug therapy. If inflammation of bleeding or laboratory found trichomoniasis, metronidazole (Flagyl) 0.2g dissolved into the vagina 1/d for 7 days. Combined with other specific vaginitis according to the appropriate treatment principles. Handful of the vaginal wall polyps bar should be removed after the pathological examination. pathological examination of vaginal botryoid sarcoma, required chemotherapy and radical surgery.
vaginal surgical repair technique where the principle of urinary fistula and fecal fistula formation, are required surgical repair, surgical repair:should generally be
(1) wait for 3 to 6 months until the inflammation subsided, scar softening, local blood supply back to normal after surgery.
(2) bladder stones associated with inflammation, should be in control of inflammation underwent stone and repair.
(3) on a regular basis menstrual cramps, menstrual net 3 to 7 days of surgery.
(4) when necessary to preoperative dexamethasone, prompting scar softening.
(5) preoperative 3 to 5 days with 1/5000 potassium permanganate solution bath, fecal fistula repair surgery three days into a small residue diet and oral antibiotics norfloxacin, or A metronidazole to control intestinal bacteria.
(6) urinary fistula after repair of the need to indwelling catheter for 7-14 days, to ensure the continued patency of bladder drainage, prevent urinary tract infections, fecal fistula repair were treated with protopine, control 4 to 5 days Do not defecate.
4. vaginal adhesions dissection long-term indwelling foreign body in the vagina can cause vaginal adhesions or partial vaginal atresia should be the surgical separation. Le SQ reported that a 21-year-old woman complained of dyspareunia and secretions stench five years, two years to seek treatment for infertility multi examination revealed tenderness clumps after vaginal vault, vaginal middle of the ring granulation tissue to the naked eye tissue the top there are holes for the discharge of purulent secretions. Vault after vaginal ultrasound confirmed a mixed mass of 5.4cm × 5.0cm × 5.1cm; try the injection of contrast agent from the hole, showing the cylindrical contours of objects in the vagina, no uterus and fallopian tubes, pelvic mri prompted a 3.8cm × 2.8 cm cup-shaped object, the external wrapping a thick liquid and soft tissue, which determine abnormal vaginal vault is formed by the foreign body and surrounding the foreign body granulation tissue. Then fistula mouth incision and expansion, see a large number of malodorous secretions discharge, separation around hyperplasia tissues, will be buried plastic caps (3.2cm × 2.2cm) remove, removal of excess scar tissue, so that the top of the vagina to widen deepen. Placed on postoperative vaginal mold to prevent re-adhesion without any memory of the patients for the presence of foreign bodies, long-term proliferation of granulation tissue surrounding the Top of the vagina atresia, fistula formation of the hole is its appearance seems to cervix, mouth, diagnosis is more difficult, the need With auxiliary examination and pelvic MRI.
5 laparotomy vaginal foreign body-induced complications, most of transvaginal surgery to solve a very small number are required laparotomy, such as pelvic abscess caused by vaginal foreign body, broad ligament abscess, ureteral vaginal fistula, or once-line laparotomy, foreign body left in the top of the vagina. Hemelt reported a 70-year-old women because of vaginal prolapse by abdominal line fixation of sacral vaginal postoperative readme chronic pelvic pain and vaginal discharge. pelvic film prompted the substance of the "needle" in the vaginal cuff, laparotomy foreign body is found a short medical cotton swabs due to negligence are left in the vaginal cuff. The Binstock reports a 4cm hard objects in the vagina of the patient removed under general anesthesia, an aerosol deodorant cover of the patients with concomitant ureteral-vaginal fistula, vesicovaginal fistula and rectovaginal fistula, therefore laparotomy the anastomosis of ureter bladder surgery and vesico-vaginal fistula repair, as well as through the vagina by vaginal wall repair.
6. treatment of toxic shock syndrome in intensive supportive therapy is key to successful treatment.
(1) to replenish fluids and electrolytes in the early start, and to monitor central venous pressure, pulmonary wedge pressure and urine output to guide treatment.
(2) early laboratory tests, and pathogens training.
(3) hypotension when Dopamine; naloxone can antagonize the endorphins role to correct the hypotension. If the adult respiratory distress syndrome requiring mechanical ventilation; case of renal failure requiring hemodialysis.
(4) after diagnosis of early application of corticosteroids can reduce disease hazards and reduce the fever course of the disease.Although
(5) the S. aureus does not exist in blood circulation, or should the resistance to β-lactamase antibiotics such as nafcillin (ethoxycarbonyl naphthalene penicillin), oxacillin (oxacillin) or methicillin (methicillin) intravenous or intramuscular injection, if you are allergic to penicillin can be switched to vancomycin 500mg. Must reduce the dose of renal injury.

complications

bladder schematic diagram of the most common complications are:
1. vaginal fistula long-term existence of solid foreign body in the vagina oppression of the local tissue, causing ischemic necrosis, and even invade the bladder or rectum, a vaginal fistula, urinary fistula and fecal fistula, resulting in urine or feces by vaginal discharge.
(1) urinary fistula: The main clinical manifestations of urinary leakage, in the form of the leakage of urine leak in different parts vary such as vesico-vaginal fistula, usually can not control urination, urine outflow from the vagina; urethra vaginal fistula only when the leakage of urine in the bladder filling; side of the ureteral-vaginal fistula due to contralateral urine may enter the bladder in urine leakage at the same time still independent urination; fistula roundabout take a certain position does not leak urine, change position after the leakage of urine.
The most common urinary fistula caused by vaginal foreign body is a vesico-vaginal fistula Hu Jianming reported vaginal foreign body vesico-vaginal fistula a huge bladder stone in 1 case, patients 21 years of age, vaginal leakage of urine six-year period six years ago, menarche a plastic shampoo bottle into the vagina tried to stop the blood outflow, and then gradually urinary urgency and vaginal leakage of urine. Physical examination: vaginal see across the anterior vaginal wall and bladder wall about 3cm × 3cm plastic foreign body cap mouth buried in the bladder of the anterior vaginal wall and the external urethral orifice turn urine oozing from the cap next to the x-ray kub shows the bladder area, see 15cm x 15cm high density shadow, diagnosis: ① vaginal foreign body; ② vesico-vaginal fistula; the ③ bladder stones in the epidural block anesthesia for bladder cut stone and vesico-vaginal fistula repair surgery to open the bladder to see mucosal congestion and edema, intravesical see 15cm × 15cm large stones to the cap as the core form and plug the urethra, was discharged three weeks after surgery, follow-up four years without exception.
Japan in recent years, reported a total of six cases of vaginal foreign body caused by vesico-vaginal fistula One of them is hair spray cans into the vagina, can not be together remove the cap, eventually complicated vesico-vaginal fistula. Line vesico-vaginal fistula repair surgery two months later the patient after abdominal
ureteral-vaginal fistula are rare the Binstock report one cases of vesico-vaginal fistula with ureteral vaginal fistula vaginal foreign body causes 52-year-old five years ago to seek treatment menopause due to vaginal odor and vaginal itching, examination revealed posterior vaginal wall near the rectovaginal separated at an oval, hard mass, initially suspected genital tract tumors. The next patient urine leakage further check suspected vaginal foreign body, line episiotomy the surgery to remove the of FAW fog deodorant plastic cap, repair leak, and placed suprapubic catheter. Postoperative still leak urine intravenous pyelography showed right hydronephrosis cystoscopy vesico-vaginal fistula and the right ureter unclear. Further confirmed that line the ureter-bladder anastomosis-vaginal fistula caesarean section from the ureter, bladder stent placement, two months after the recovered milk perfusion bladder and intravenous indigo carmine test
(2) fecal fistula: rare complication of rectovaginal fistula in the vaginal speculum exposure can directly get a glimpse of the fistula hole fistula hole very small, often saw in the posterior vaginal wall to a color red granulation tissue, with a probe detection from here, while another finger into your vagina to directly touch the probes to the diagnosis of small intestine or colon-vaginal fistula need before being diagnosed by barium enema.
2. translocation into the adjacent organs into the bladder to the formation of bladder stones; or penetrate the vaginal vault into the pelvic cavity to form the pelvic foreign body, broad ligament foreign body Pan Xuezhen report one cases of 21-year-old patient 10 years ago of unknown causes on their own A perfume bottle stuffed needle-like pain in the vagina was a sense of the vulva and vagina, vaginal bleeding severe abdominal pain is not ashamed to seek medical treatment since often pale yellow fishy liquid discharge during intercourse vaginal foreign body sensation associated with painful intercourse times the foreign body was not successful. The gynecological examination: vaginal patency, to see large amounts of purulent discharge, bad taste, the vaginal mucosa is rough, thickened, granular formation of scar tissue cervix lower lip defects, the hard right parametrial palpable rigid package and the size of a 4cm × 5cm block boundary is unclear, poor activity, no obvious tenderness. pelvic x-ray showed: pelvic foreign body was in continuous epidural anesthesia for laparotomy and intraoperative see see pus out of a hard mass in the right broad ligament cut envelope, a 2cm x 2cm size of the cylindrical metal perfume out of the abscess cavity caps, treatment for 12 days and were discharged.
3. pelvic infection abscess formation In addition to the long-term vaginal foreign body causing chronic inflammation of the vagina, such as vaginitis, vulvitis cervicitis; inflammation of the urinary tract such as cystitis, urethritis outside cause connective tissue proliferation, polyp formation, sexual life when the external force can lead to foreign body penetration of the vagina migrate to the pelvic and even within the broad ligament, the formation of pelvic abscess, broad ligament abscess; serious spread of the infection, causing pelvic peritonitis, septic shock and sepsis.
vaginal adhesions part of the vaginal atresia chronic inflammation caused by local proliferation of granulation tissue scar formation, the serious impact of blood to rule out abnormal vaginal bleeding or long-term sepsis secretions caused by poor blood discharge, amenorrhea, with cyclical lower abdominal pain or continuous abdominal pain vaginal top of the latch allows the vagina to reduce the pain during intercourse, or dyspareunia.
5. cervical scar vaginal foreign body a long time for the vaginal vault and cervix scar tissue formed by labor can affect the cervix to open a large and fetal decline in, resulting in soft producing obstruction dystocia, such as simultaneous strong contraction of the uterus, can cause uterine rupture. Such cases end to choose cesarean section childbirth safer.
6. toxic shock syndrome (toxicshocksyndromeTSS) toxic shock syndrome, menstrual plug caused by improper. The peak incidence of the levy was first reported in 1978, mostly in the 12 to 24 years old, passing women and application of super-absorbent menstrual plug linked to the majority of cases appeared in California, Minnesota, Wisconsin, after August 1980 The incidence of sharp decline in annual incidence rate of women passing 6/100 000 7/100 000. toxic shock syndrome in the following situations occur: after childbirth and women using the diaphragm, after surgery, or merge in the past 10 years, with only mild soft tissue abscess or osteomyelitis of the incidence of male or female non-menstrual disorders improved.
(1) clinical manifestations: high fever, body temperature higher than 38 ° C (102 ° F), with severe headache, sore throat, vomiting and diarrhea, similar to sepsis and meningitis. blood pressure dropped to shock and may have erythema rash muscle pain, mucosal hyperemia, liver and kidney dysfunction, disorientation, and cardiac dysfunction within 48h
(2) pathogenesis: the incidence of this syndrome by Staphylococcus aureus exotoxins (pyrogenic exotoxin C) caused by the bacteria themselves, the toxins can cause high fever, at the same time can enhance the susceptibility of patients with endotoxin caused shock and liver, renal and cardiac damage. Menstrual plug insertion may cause mucosal damage menstrual countercurrent and peritoneal absorption of bacteria and toxins. May carry more aerobic oxygen left inside the fiber gap. The menstrual plug placed in the longer the possibility of this risk, the greater to give up the women with menstrual plug can be completely avoided the risk of the disease.
(3) prognosis: toxic shock syndrome case fatality rate of 3% to 6%, three of the major causes of death in the adult respiratory distress syndrome refractory hypotension and secondary diffuse intravascular coagulation (DIC), bleeding.

prognosis and prevention

prognosis: Concurrent toxic shock case fatality rate of 3% to 6%.
Prevention: vaginal bleeding, increased secretions, vaginal foreign body sensation and urgency, dysuria, and patient flow, especially young girls should carefully identify the cause of aggressive treatment to prevent complications.

epidemiology

vaginal foreign body is not uncommon in clinical practice, vaginal foreign bodies can occur at any age, young girls of the domestic common, can also be found in the mentally ill adult patients; abroad normal adult women have also occurred.

Special Note

vaginal bleeding, increased secretions, vaginal foreign body sensation and urgency, dysuria and patient flow, especially young girls should carefully identify the cause, active treatment, to prevent complications.


[Cause]

boil is caused by what the?

infection and skin dirty, scratches, high ambient temperature or lower the body resistance to infection-related. Boils can occur in any follicles of the skin area, often to the head, face, neck, armpits and buttocks so often by the friction of the parts is more common.

(a) causes

boil the pathogenic bacteria Staphylococcus aureus based, Streptococcus, Staphylococcus epidermidis, are also caused by the disease. Local and systemic skin's resistance to infection is reduced mainly due to Benbingfasheng, so infants, malnutrition, diabetes is a good risk of this disease. Dirty skin, skin abrasions, high ambient temperatures often lead to local infection such as the direct cause.

(B) the pathogenesis

bacteria invade the hair follicle and their sebaceous glands and sweat glands, in hair follicles and surrounding tissue multiply rapidly, producing toxins, causing local tissue degeneration, necrosis, and the center of the formation of boils, the performance of local congestion, exudation, induration. Aggregation of neutrophils to the damaged body tissue cells and bacteria to be destroyed, and he gradually necrosis and dissolution, the formation of abscesses in the dermis. Due to Staphylococcus aureus, coagulase contain toxins, so the formation of pus bolt, protruding outward. Swelling and induration clinically visible in the center of a yellow-white pus plug. This is Staphylococcus aureus infected lesion characteristics. Ulceration after discharge pus, abscess gradually by the new fibrous tissue repair and healing.

[Sign]

boil the early symptoms?

1. redness, swelling, heat, pain summary, cylindrical cone.

2. inflammation to the development of nodules increases, the pain intensified.

3. A few days later nodules central necrosis, abscess formation, dissolution, soft induration, pain relief, the central pus head most of the self-rupture, discharge pus, inflammation subsided recovery.

4. furuncle usually no obvious symptoms, but if the blood flow occurred in the rich parts of the body resistance weakened, it can cause discomfort, chills, fever, headache and loss of appetite and other symptoms of toxemia.

5. Facial Boil such as intracranial infection, facial swelling and severe, may be associated with chills, fever, headache, sinus infections and other embolization.

boil because of location, severity of different clinical manifestations may vary.

local swelling and pain sclerosis: no systemic symptoms of early disease and more, only infection redness, swelling, pain, range of not more than 2cm in diameter, small nodules gradually enlarged, as papules bulge. A few days later lesions extended about 3 ~ 5cm, nodules gradually softened, the center was white, a slight touch of the fluctuations; then ulceration pus, and the emergence of yellow-white pus plug. Pus bolt off, pus shed, the inflammation subsides and healing. There is no pus boil bolt (the so-called headless boil), since the collapse a bit late, need to find ways to promote its pus discharge (Figure 2 ).

fever, swollen lymph nodes: furuncle serious infection, the local area of ​​the lymph nodes, tenderness, and may be associated with body heat, and sometimes lymph node abscess formation.

nose, upper lip and around (called "dangerous triangle") of the surface boil, add or pushed in touch, the bacteria via the angular vein, ophthalmic vein into the brain, causing intracranial suppurative infection. At this point may have fever, headache, vomiting, consciousness disorders.

early follicular redness, swelling, heat, pain, induration. After the white purulent center, there is volatility. May be associated with systemic fever, elevated white blood cell count and differential count.

[Aftertreat]

boil ate?

therapeutic side:

1. composed of: a single head of garlic, honey, 9 grams. Usage: pound evenly wrap the affected area.

2. consists of: single head of garlic amount. Usage: Peel and slice into 2 to 3 mm, with the first affected area with warm salt water when dry wash, and then sticking garlic, and gently massage the 10 to 20 minutes, 2 or 3 times a day, 2 3 There is no more. Indications: Boil, folliculitis. Note: In severe cases, such as local irritation may reduce the massage time, a serious condition should be added to serve anti-inflammatory drugs.

3 . composed of: tea 2 grams of dried honeysuckle 1 gram. Usage: boiling water 6 minutes after each meal drink in a cup. Indications: Boil, exogenous heat.

4. composed of: fresh Malan first 100 grams, the amount of liquor. Usage: Add a little salt before blindly smashed wine Ban Cheng paste, coating the surface of the skin furuncle carbuncle. Indications: furuncle, carbuncle.

5. Composition: rosin 10 grams of white wine. Usage: rosin research to fine tune white wine into a paste, resisting heat, wrap the affected area after dissolution, for the degree of responsibility to cover all of the above and then covered with wax paper and tape securely, to enhance efficacy, can drop a few drops of wine, rosin to keep moist. Indications: furuncle, carbuncle, folliculitis.

6. smashed topical papaya leaves, swollen boil carbuncle treatment drug.

7. fresh peach leaf, plug smashed the lesion, treatment of nasal furuncle.

8. rhizome or fresh banana leaves smashed Jiao Zhi, coating the surface of the skin, cure carbuncles, boils, swelling.

9. almond powder with sesame oil paint, heat treatment boil.

10. Purple cane coal deposit of the skin, powder, paint the affected area or sesame oil dressing, boil carbuncle treatment, stomatitis , eczema.

11. raw taro add a little salt, smashed drunk wrap the affected area twice a day replacement, bones can cure pain, swelling of unknown drugs, pediatric head hot boil, finger boil.

12. raw loofah (or leaf), smashed juice, coated surface of the skin, soak sore treatment days, yellow water sores, heat boils, urticaria .

13. mung bean sugar kelp: seaweed 60 grams, shredded, green beans, 150 grams, with the soup, add brown sugar to taste food. There Sedative, diuretic, soft-kin, Phlegm, scattered gall tumor effect. For hypertension, beriberi edema, neck lymphadenopathy, simple goiter, prickly heat boils hot summer day in children poison, phlegm cough embolism.

14. yi melon soup: melon (not peeled) 500-600 g, yi 50-100 grams of soup. Can be flavored with sugar or salt, on behalf of the tea used, heat, hot weather, diuretic, dehumidification effect. Drugs for Rush boils, eczema athlete's foot, yellow urine deficient.

15. Daozhi raw turnip, vinegar and rub the affected area transfer, heat treatment boil.

16. green beans 30 grams of powder, each 10 grams, water delivery service, boils cure breast swelling and pain.

17. failure to adopt the open rose 3 - 5 朵 wash, add water, two pregnant, suffering from a cup of low heat, ice sugar 30 grams, made of rose soup, until the temperature dose, to cure blood stasis amenorrhea, boils Chung pain, traumatic swelling and pain.

18. boils and pus ulceration of the skin sore or eczema, rinse with water, tea, allow the wound clean and promote healing.

19. a white sweet potato, peeled and chopped, smashed, can also be added with the same amount of fresh Houttuynia smashed, spreads in the affected area, apply to the local heating that line replace (about two three hours long), and even apply a few days more, boils cure mastitis.

20. soybeans amount, turn on the water immersed soft, add a little alum were smashed drunk, external surface of the skin, swollen boils boil treatment.

21. adzuki beans with water until soft, mash with water or vinegar, or honey or egg amount, into a paste, external surface of the skin, cure mumps, hot boil.

22. Kapok 30 - 50 grams of sugar amount, fry a bowl with water and drink two bowls and a half. Favorable moisture, heat effect. For enteritis, urethritis, eczema, summer boil embolism.

23. fresh buckwheat leaves 60 grams, Shuijianbi day one; or fried yellow noodles with the vinegar into a paste, applied to the lesion, sooner or later be replaced. Governance sore, swollen boils, erysipelas, mastitis, and swelling of unknown drugs.

appropriate patients to eat what?

1, edible grapes plus zinc salt or zinc, other foods such as soy, sunflower seeds, wheat bran, yeast, brown sugar and so on.

2, Yi Shi taste light, the cold food, such as Malan head, purslane, melon, red and white radish, bitter gourd, sponge gourd, mung bean, red bean, lily, chrysanthemum brain and celery.

patients unfit to eat what?

not eat ginger, pepper and other spicy foods , as well as mustard, yellow croaker, shrimp, crab, chicken head, goose, Zhu Tourou so fat objects.

should avoid fried foods and meat, edible oil cans.

data only refer to the specific, please ask a doctor.

[Prevent]

how to prevent boils?

boil is born of acute suppurative superficial skin disorders, widely available health, children, young people more common. "Surgical management case" that: "boil persons, birth processes, floating red rootless feet, swollen found in the skin, only the width of an inch, there is less pain, a few days later Microsoft, thin peel, the beginning of the blue water, the latter from breaking the pus out of. "The disease occurs in the summer and autumn, protruding roots shallow, swelling potential limitations, lift the red pain, mostly in the range of about 3cm, easily swollen, easy to collapse, Yi Lian. Early can be divided into a head, without the first two kinds of general light and easy to cure the symptoms, so the saying goes, "no boil the size of a pus like." ;;; ;;;;; ;;;;; ;;;;; But also due to the formation of improper treatment or care "mole cricket boils," or repeated seizures, lack of disunion. Multiple furunculosis ", is difficult to cure.

[Treat]

boil precautions before treatment?

attention to the skin clean, timely replacement of underwear and avoid skin injuries, especially in the summer, to bathe, wash your hair, hair, changing clothes, nails, children in particular should pay attention. With honeysuckle and wild chrysanthemum Jiantang tea. Boil the surrounding skin should be kept clean and coated with 70% alcohol to prevent infection spread to nearby hair follicles.

boil Chinese medicine treatment methods

total boil caused by the toxic heat treatment to detoxify the basic principles.

A Differential Treatment:

1. Heat toxin Accumulation card: lesion processes, such as cone, burning pain, or fever, thirst, tongue pink, yellow fur, rapid pulse. Detoxification. Flavors disinfection decoction.

2. Shushi heat Melancholia: seen in summer and autumn, the affected area, such as agglomeration cone, single or multiple, burning pain, chest tightness, anorexia, deficient urination, red tongue, greasy or yellowish, veins slippery. Qingshu dampness, detoxification swelling. Qingshu Decoction.

3. Is virtual evil love cards: distributed in the body, local color dark red, pus scarce, one after another, delayed healing, with fever, irritability, thirst, or fatigue, limb soft, red tongue thin yellow, rapid pulse. Righting detoxification. Liu Wei Di Huang Decoction.

Second, external treatment and other treatment:

1. The beginning of detoxification should be swelling, moderate to henbane, water reconcile, wrap the affected area. Or wishful golden powder for external application. Or green cream Waicha.

2. Pus, the clip bolt out the pus.

3. Unhealed after the collapse, sores can be a little ninety-one Dan to drugs or drug line twist into sores, topical berberine gauze.

4. Oral Meihuadianshe Dan, Niuhuangjiedu, Fang Feng Tong Sheng Wan, Liushen other medicine.

5. Unilateral prescription: Silver Flower 30g, licorice 10g, decoction, on behalf of the tea.

Western boil treatment

1. Local treatment, such as heat, physical therapy, 10% ichthyol coated ointment. Facial Boil should rest in bed should not squeeze or prick Boil, so as not to spread to the brain.

2. Swelling or have a large range of obvious symptoms, should give systemic antibiotics (third-generation cephalosporin antibiotics).

3. The formation of abscess, incision and drainage should be timely but should be avoided Boil the face cut.

(a) treatment

1. The principles of early treatment to promote inflammation subsided, after early drain purulent pus; timely elimination of systemic adverse reactions.

2. Local treatment

(1) Physical therapy: early, ultraviolet micro-irradiation, can promote local anti-inflammatory, to prevent proliferation. Swelling stage, the selection of FM, infrared and other heat, promote Boil liquid. 2 to 3 times / d, 20 ~ 30min / times.

(2) Drug eraser: 0.5% povidone-iodine scrub, the drug not only for skin irritation, and the role of long-lasting, no pigmentation. Can also be used erythromycin, tetracycline ointment.

(3) topical cream: local swelling and a small pustules, use ichthyol, wishful golden powder, Gyokuro powder and so on.

(4) incision and drainage: Boil into pus, nodules soften, a sense of volatility, you can make a small incision drainage or fire needle drainage. Taboo squeeze purulent lesions.

(5) to keep local clean and dry: adhere to local skin cleaning, daily showers are the best conditions. Young children with skin, topical lip after taking a bath in summer, to avoid the formation of multiple Boil.

3. Systemic treatment usually does not require systemic treatment of boils. But facial boils or accompanied by chills, fever, headache, general malaise, etc., should be given antibiotics. Clinical observations and experimental results show that the efficacy of penicillin, cephalothin, cefazolin and amikacin better effect.

(B) the prognosis

generally good prognosis after active treatment, without sequelae.

[Examine]

boil should be how?

1. Peripheral blood

(1) white blood cell count: fever, elevated WBC count may have.

(2) white blood cell count: white blood cell count was elevated often accompanied by increased neutrophils .

2. diabetes check

(1) fasting plasma glucose measurement: two fasting blood glucose were increased, should consider the possibility of diabetes.

(2) glycated serum protein: This clinical trial is not the impact of fluctuations in blood glucose higher than normal to help the diagnosis of diabetes.

(3) glycosylated hemoglobin: glycosylated hemoglobin and blood glucose were positively correlated, and the irreversible reaction. Diabetes is often higher than the normal 2 to 3 times.

3. bacteriologic

(1) bacterial culture: the multiple, repeated infections, abscesses can be extracted directly pus for bacterial culture, positive results will help the diagnosis of pathogens.

(2) drug susceptibility testing: bacterial culture in the pus, while line drug susceptibility testing can provide the scientific basis of clinical drug treatment.

[Diff]

boil diseases easily confused?

1. Multiple sweat gland abscesses are summer disease, more common in infants and young children and frail mother's head, forehead, etc .. Lesions of multiple subcutaneous abscesses. Surface tenderness, inflammation lighter. No pus bolt, left scars. Usually accompanied by a lot of prickly heat. Generally known as prickly heat poison. It was also known as pseudo furunculosis (Pseudofurunculosis).

2. Hidradenitis suppurativa common in young women, lesions of the skin induration. Subcutaneous abscess formation, followed by skin redness, swelling, heat, pain, ulceration scarring. Lesions occur in the armpits, groin, genital and perianal, umbilical, etc.

3. acne acne mild infection, red, swollen, painful, but the disease is small, the top a little bit like creamy.

4. sebaceous cysts sebaceous cyst infection are redness, swelling, pain, but the previous round has been painless mass over an extended period , the epidermis as usual.

5. carbuncle carbuncle with redness, swelling, pain, but there are several hair follicle infection, lesions larger than the boil.

[Disease]

hump-related diseases

juvenile osteochondrosis of vertebral osteoporosis youth sexual hump sore scoliosis ankylosing spondylitis vitamin D deficiency disease

more back symptoms

small blisters appear back back pain back spasms, back pain does not have subtle linen spine back pain sinus pain Road with sensory ataxia spinal nerve root damage spinal cord hemisection syndrome, spinal cord lesions of hemorrhagic infiltration of the spinal cord injury spinal cord infarction, cauda equina involvement across the spinal cord within the spinal cord gliosis in the spinal cord anterior horn of the spinal cord lesion cavity formed spinal thalamic tract compression


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