Abscess Of The Buttocks After Injection - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Abscess of the buttocks after injection

An abscess after an injection is a complication that occurs after a medication is given intramuscularly or intravenously. As a result of infection of the skin and muscles, a purulent focus occurs at the injection site. It is important to differentiate between an abscess that occurs after injection and a phlegmon. With an abscess, a purulent focus has a limited localization, a well-distinguishable border separating it from healthy tissue. With phlegmon, this border is blurred, the area of inflammation is much larger.

Content:

• Causes of pathology
• The most common localization of abscesses after injection
• Symptoms and manifestations of an abscess after an injection
• Complications of gluteal abscess
• Diagnostics
• General treatment
• Operative treatment
• Prevention

Causes of pathology

The main reason for the appearance of an abscess after injection is a gross violation of the rules of antiseptics.

Ways of introducing infection into the tissues of the human body:

• Insufficiently well-treated hands of the medical staff;
• Non-sterile consumables used for the injection (syringe, injected drug, napkins);
• The patient's skin is not well treated before and after the administration of the drug.

As a result of a safety violation during the injection, severe complications arise.

Etiological causes of abscess formation:

• Violation of the injection technique - using an insulin syringe for intramuscular injection, insufficiently deep needle insertion (you need to insert the needle at least 2/3 of its length);
• Violation of the rules for the administration of drugs, for example, intramuscular administration of a drug intended for intravenous infusion or subcutaneous administration. Due to such a gross error, the drugs not only do not dissolve, but also form an aseptic or infectious infiltrate.
• High concentration of injections in one place with a long course of treatment;
• Thick layer of subcutaneous fat in obese patients;
• Long-term administration of irritating drugs (magnesium sulfate, antibacterial agents);
• Formation of a hematoma due to the penetration of the needle into the capillaries and larger vessels;
• Scratching the itchy injection area with the patient's hands;
• The presence of purulent skin or autoimmune diseases;
• A history of allergies;
• Decreased immunity in HIV-infected people, in the elderly.

The most common localization of abscesses after injection

Since most injections are performed in the gluteus muscle, which has a developed fat layer, it is in this muscle that a significant number of abscesses are formed. Fatty tissue is the most favorable environment for increasing the colonies of microbes that have entered it.

Another area in which post-injection abscesses are often formed is the anterior or lateral surface of the thigh. It is into it that patients inject the medicine who are forced to inject themselves on their own.

Symptoms and manifestations of an abscess after an injection

The deeper the abscess has formed, the less visual symptoms of inflammation appear. Nevertheless, the painful sensations during mechanical action on the inflamed area can be very strong.

Post-injection abscess is characterized by the classic symptoms of the inflammatory process, complicated by the formation of pus.

Local manifestations

Common signs of inflammation

Swelling and swelling of the injection site; Hyperemia of the skin over the abscess; Soreness during mechanical action at the beginning of the process, severe pain without pressing during the development of the disease; Hyperthermia of the site of inflammation, the skin above it is hot; The presence of fluctuation - when palpation and pressing with the fingers of one hand on the affected area, the fingers of the other hand are raised; Formation of fistulas with complicated purulent inflammation, spreading the infection outside and inside tissues.

Decreased performance; Lethargy, weakness; Increased fatigue; Significant hyperthermia (up to 39-40 ° C); Hyperhidrosis.

The development of an abscess and fistulas are the last stages of the inflammatory process. Before purulent fusion of tissues occurs, an infiltration is formed. If its treatment is started in a timely manner, in many cases it is possible to avoid the formation of a widespread purulent focus.

The more pronounced the purulent process, the more severe the symptoms of intoxication, since a large amount of toxins enter the bloodstream.

Complications of gluteal abscess

A distinctive feature of post-injection abscess is the formation of a special capsule (pyogenic membrane) around the infiltrate. Due to this, the inflammatory process is limited to its space, without spreading to healthy tissue. Excessive accumulation of pus and the resulting pressure on the tissues in advanced cases leads to rupture of the capsule shell. The consequence of this is the spread of pus into interstitial structures, into muscles and the space between them. An extensive phlegmon, external and internal fistulas are formed.

Phlegmon is formed more often than other complications. In complicated cases, sepsis (blood poisoning) and poliomyelitis develop.

Diagnostics

To make a diagnosis, in many cases, the doctor has enough data from a visual examination, palpation of the affected area, analysis of the patient's complaints.

Laboratory research:

• General blood analysis;
• General urine analysis;
• Bacteriological sowing of infiltrate on microflora;
• Biochemistry of urine.

Instrumental research:

• Ultrasound to assess the prevalence of inflammation;
• CT, MRI (computed or magnetic resonance imaging) - is used in the diagnosis of extensive purulent tissue damage.

General treatment

When prescribing treatment, the doctor focuses on the causative agent of the infection detected as a result of bacterial culture, separated from the wound, as well as on the severity of the patient's condition. Usually, analgesics and antibacterial drugs are prescribed at the same time. Limiting therapy to conservative treatment alone does not always lead to the desired outcome. An abscess can provoke extensive necrosis, sepsis. For successful treatment in many cases, it is required to open a purulent focus and aseptic processing of its cavity.

Treatment at the initial stage of infiltration formation:

• Termination of injections into the affected area, emergency initiation of therapy;
• The use of physiotherapy (gamma globulin electrophoresis, treatment with dynamic currents);
• Introduction to the area of infiltration of proteolytic enzymes;
• Dynamic observation of the development of the infiltrate - if fluid is found in it during an ultrasound scan, with severe pain and tissue swelling, surgical treatment is prescribed.

Operative treatment

Self-medication during the formation of a post-injection abscess is strictly prohibited, as well as expectant tactics. Purulent fusion of soft tissues forms rapidly, necrosis forms, and the area of inflammation expands.

The most effective surgical technique of treatment is surgical necrectomy, or excision of nonviable tissue.

Intervention stages:

• Formation of the primary seam.
• Enzymatic necrolysis.
• Vacuum aspiration of pus with drainage.
• Subsequent flush drainage using sodium hypochlorite and proteolytic enzymes.

The last stage helps to prevent secondary infection. Such a closed method of treatment promotes the speedy healing of the tissues affected by the abscess.

The previously used method of open treatment without the formation of a primary suture in 30% of cases led to infection of patients. The most common source of infection was Pseudomonas aeruginosa.

Puncture of the buttock abscess, which was common earlier, is no longer relevant as a method of treatment. Such manipulation provokes complications in the form of phlegmon, purulent streaks, the transition of the process to a chronic form.

Prevention

Post-injection abscess of the buttocks leaves behind an unaesthetic scar with the formation of a fossa on the skin and deformation of adipose tissue.

Preventive measures to prevent complications arising after injections:

• Strict adherence to dosage, drug compatibility, speed of administration and frequency of the drug;
• Compliance with the rules of drug administration - full penetration of the needle into the gluteal muscle tissue;
• Strict adherence to the rules of antiseptics, the use of sterile consumables, careful treatment of the injection site and the hands of the person performing the injection;
• Accurate determination of the topography of the injection, which is difficult to do in the treatment of obese patients with pronounced subcutaneous fat at the injection site;
• Relaxing massage to improve drug absorption;
• The ban on the introduction of drugs in the same place.

After the surgical intervention, the patient is under medical supervision for 10-14 days. In the absence of somatic diseases, the prognosis of cure is favorable. Rehabilitation consists in restoring the skin, the activity of the limb muscles, and increasing the patient's working capacity.

It should be mentioned that more than 90% of all post-injection complications are based on bacterial origin. Staphylococcus aureus is considered the main causative agent of all kinds of suppuration. Pseudomonas aeruginosa is also common. As a rule, after opening the focus of infection after 3 dressings, the amount of sowing Staphylococcus aureus decreases, and an increase in the sowing rate of Pseudomonas aeruginosa indicates re-infection. In rather rare cases, bacteria of the genus Escherichia coli and Proteus can be found.

Previously, dangerous cases of Clostridial anaerobic infection were recorded, which has not been observed recently. Strict adherence to certain rules of drug administration technique, injection technique and adherence to asepsis provides full protection against unpleasant occurrences of an abscess after an injection. All modern experts recommend, if possible, to limit the conduct of such procedures at home.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.