Suture fistula after cesarean section
Ligature fistula after surgical delivery is one of the most common complications of this operation. It is dangerous because it is a source of infection and can cause toxic damage to a woman's body.
Each operation, and delivery by cesarean section is no exception, ends with a suture. The purpose of the incision 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 forms around the threads, an abscess is formed with purulent fusion of tissues. Generally accepted requirements for the antiseptic of the surgical material and the surgical site prescribe a thorough treatment of the incision before suturing. If pathogenic bacteria get into the wound, an inflammatory process will inevitably develop, complicated by the formation of a fistula.
Around the ligature, tightening 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. A ligature fistula may be the only one, or pus erupts in several areas of the surgical suture.
The time for the formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula can spontaneously close for a while, but the final recovery does not occur until the source of suppuration is eliminated.
Content:
- Reasons for the appearance
- The danger of education
- Symptoms
- Diagnostics
- Treatment
- Operative treatment
- Conservative treatment methods
- Prevention
Reasons for the appearance
For the appearance of a fistula after a cesarean section, there must be predisposing factors.
Frequent reasons for the formation of a ligature fistula:
- Infected suture material
- Infection of the operating field;
- Poor ligature quality;
- Violation of antiseptic rules during and after surgery;
- Incorrect processing of the surgical suture;
- Reduced immunity.
The stress associated with pregnancy and childbirth, a stress factor, weaken a 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 forms on the suture left after a cesarean section, you need 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. When the fistula breaks, 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 body's reaction to the formation of a purulent focus and the accompanying high temperature, negatively affects the functioning of most organs;
- The appearance of phlegmon is the spread of inflammation in the subcutaneous fatty tissue;
- Abdominal prolapse from a molten wound.
It is possible to prevent the appearance of complications only by timely diagnosis of a ligature fistula.
Symptoms
Women who have undergone a caesarean section should know the main symptoms of the onset of pathology, because a ligature fistula can form several months after the operation.
Signs of pathology:
- Redness of the skin;
- Seam sealing;
- Swelling of tissues;
- Higher temperature of the 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, the temperature values may be close to normal, but still increase. The more the inflammatory process develops, the more pronounced the hyperthermia.
Diagnostics
Not all women can independently detect the onset of the inflammatory process in time. Usually, the patient seeks a doctor when the wound infection has gone too far. If the wound after a cesarean section is regularly examined by a specialist, it is possible to detect the pathological process at the earliest stages, to prevent complications.
Diagnostic methods:
- Palpation of granular tissues;
- Study of anamnesis, patient complaints;
- Probing of the ligature fistula to determine the parameters of the defect;
- Contrast ultrasound;
- X-ray examination with the introduction of a 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 in a surgical hospital is it possible to prevent the spread of infection, open suppuration and remove a fistula.
Operative treatment
There are two tactics of surgical treatment of a ligature fistula - the doctor removes the thread that caused the inflammation, or excises the entire fistula, which is preferable in many cases. The thread is pulled out 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 the inflammation, the fistula is finally tightened. If there are relapses, the operation is repeated.
A wide incision is not made because there is a risk of cellulitis and 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 drugs, and 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 the inflammation.
A radical way to get rid of the focus of inflammation is the sole excision of the fistula. In this case, both the fistulous canal and the suture material that caused the pathology are removed. The operation is carried out under local anesthesia, with careful observance of antiseptic rules. After removal of the fistula, the wound is sutured, its condition is monitored for 5 days. After healing of the site of excision of the fistula, the stitches are removed from the wound.
Conservative treatment methods
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 throughout the wound area. Treatments are often done to effectively remove pus and disinfect the suture area.
If in this way it is possible to stop the inflammation, the ligature fistula can heal spontaneously. To support the immune system, immunostimulants and vitamin complexes are prescribed. A course of antibiotics will help prevent the spread of the infection. When the body's defenses 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 adherence to the rules of antiseptics during a cesarean section, there is a risk of a ligature fistula. It is impossible to predict in advance whether a woman will have a suture rejection reaction or not. However, preventive measures will help prevent complications from occurring.
Preventive measures:
- Rational management of the caesarean section;
- Compliance with the rules of antiseptics;
- Thorough preparation of the operating field;
- Use of modern surgical materials.
In order to prevent the development of suture inflammation after a cesarean section, you need to closely monitor its condition for several months after the operation.
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.
