2 English reference vaginal foreign bodies
3 disease code ICD:T 19.2
4 Classification of Obstetric and Gynecological Diseases
5 disease overview * * * Foreign bodies mainly show increased secretion and infection. If it is not removed for a long time, it may cause urogenital fistula, ulcer, pelvic abscess and calculus. It is not uncommon in clinic, it can occur at any age, it is also common in China, and it can also be seen in adult mental patients. Normal adult women in foreign countries also happen from time to time.
6 disease description * * * foreign bodies are mainly characterized by increased secretion and infection. If it is not removed for a long time, it may cause urogenital fistula, ulcer, pelvic abscess and calculus. It is easy to cause misdiagnosis and bring great pain to patients physically and mentally.
Symptoms and signs 1. symptom
(1) painful bleeding: large foreign bodies, such as folk "taking medicine", can cause severe painful bleeding, or glasses, perfume bottles, etc. When trying to take it out, it broke and damaged the wall. Some patients showed long-term chronic pelvic pain or lumbosacral pain. A 75? A 25-year-old elderly patient was hospitalized for hemiplegia. The patient complained of leucorrhea and foul smell and 25? Years ago, the diagnosis of Shuanghe Town and Sanlian found that there was a spherical object in * * * *, and the surrounding granular granulation tissue proliferated, about 3 ~ 4 cm away from the mouth of * * *, and the pelvic X? X-ray examination showed that the diameter of the ball was about 4cm, so the foreign body was taken out under general anesthesia. This * * * spherical object may be at 25? This was used to treat pelvic tissue relaxation a few years ago.
(2) Increased secretion of * * * with odor: According to the nature of foreign body, it can cause acute and chronic inflammation of * * *, which is characterized by itching of * * * and increased secretion of * * with odor; Or a large number of purulent blood secretions; Or light yellow, thin and foul-smelling liquid is discharged repeatedly. Due to long-term secretion or complications leading to urinary leakage, vulvitis can be complicated, manifested as a rash on the outer or even inner thigh. After secondary infection, vulva burns and mobility is inconvenient.
* * * * The foreign body didn't hurt at that time or for a short time, or complained to his mother that it was itchy, didn't attract attention, or didn't dare to tell his parents, and was not noticed by his parents until * * * increased drainage or bleeding. Therefore, when the outpatient department encounters * * * with fluid discharge, the medical history is vague, so it is necessary to think about the possibility of foreign bodies, especially those that have not improved according to inflammatory treatment. We can't completely believe the history of foreign bodies denied by patients and make a hasty diagnosis and treatment.
(3) Foreign body sensation in * * * accompanied by * * pain: Women with a history of sexual life may feel foreign body sensation in * * * due to the size of foreign body, and in severe cases, they will have * * * pain, leading to scar formation, * * * atresia and even inability to * * *. Lesy？ Report 1? Bit 2 1? A * * *-year-old woman complained of pain and leucorrhea for five years, and formed scar adhesion in the vault of * * *, with a depth of 3.2cm×2.2cm? Plastic bottle cap.
(4) Urodynia and urgency: * * When a foreign body oppresses the bladder or is accompanied by bladder stones, symptoms of dysuria and urgency appear.
(5) When * * * foreign bodies cause complications such as urinary fistula or fecal fistula, clinically * * * may cause urinary leakage, fecal discharge through * * or paroxysmal exhaust.
2. Symbols
(1) Gynecological examination found that the vulva and perioral skin were congested and flushed, and some of them showed eczema-like changes.
(2) Foreign bodies can be found by * * * endoscopy. Infants and young children have * * * foreign bodies, such as larger and harder foreign bodies, which can be found during anal examination, but softer and smaller foreign bodies are not easy to find, so they need to be examined by nasal endoscope under general anesthesia.
(3) See * * * wall flush and congestion, and even form ulcers. The typical ulcer is located in the * * * vault, with a round edge and red particles at the bottom. The new epithelium at the edge of the ulcer will fall off.
(4) In patients with bladder fistula and rectocele fistula, fistula holes can be seen on the wall of * *, and urine and urine are polluted by * *. Individual patients have small fistulas or hidden parts, which need to be diagnosed by auxiliary examination.
(5) Long-term chronic inflammation causes mucosal granulation hyperplasia and polyps; When inflammation develops further with infection, it can form * * * stenosis, adhesion and even * * * partial atresia.
(6) When foreign bodies exist, mixed flora often exists in * *, such as Haemophilus * *, Neisseria gonorrhoeae, Chlamydia, Mycoplasma, Ureaplasma urealyticum, Trichomonas and so on. Diagnosis can only be made by secretion smear staining or culture.
8 Etiology of disease 1. * * * Foreign body source
(1) Foreign objects are stuffed by others, such as cotton balls and gauze left over from surgery or treatment; In order to enhance * * *, glasses, gin bottles, beverage bottles, metal jewelry boxes, etc. Are stuffed into * * *.
(2) Self-plugging: It is common for babies to stuff foreign objects into * * * out of curiosity or in an attempt to stop itching. Ding reports 9? A case of infant * * * foreign body, aged 3 ~ 10? One year old, with normal intelligence, and three of them were stuffed in by children of the same age? Examples; Stuffed into *** 2 by insane adults? Examples; Stuff yourself into 2? Examples; Unknown reason 2? For example.
2.*** Foreign body classification? There are many kinds of foreign bodies that have strayed into * * * *. Common ones are: hair clips, matchsticks, peanuts, corn kernels, soybeans, wheat kernels, bicycle balls, cigarette filters, small stones, plastic pen caps, hemp stems, pins, small mother-child buckles, plastic short ropes, glass ampoules and metal perfume bottle caps. Adults put cucumbers, oranges, onions, perfume bottles, penis molds, etc. Enter * * * because of seeking sex, but can't take it out eventually, or forget the contraceptive pill in * * * due to negligence.
9 pathophysiology 1. Inserting a foreign body for therapeutic purposes? Such as gauze left after operation, used for compression or hemostasis; * * * The patient who has placed a pessary for the treatment of uterine prolapse does not take it out for a long time, which leads to changes in flora and acute inflammatory reaction.
2.* * Foreign bodies are used for contraception? Leave condoms, uterine caps, cervical caps, etc. In * * *.
3. Used for abortion or induced labor? Folk "taking medicine" can corrode * * *, and some unmarried pregnant girls have their own abortions and put all kinds of foreign bodies into * * *.
4. Sex * * *? By * * * or by themselves, all kinds of foreign objects are stuffed into * * *, which is more likely to happen when drunk, which is more common in women of childbearing age and also in elderly women. Asrtid？ Novak? Report 3? An old woman's foreign body, one of which is 8 1? At the age of 18, she came to the hospital because of * * * pain and took out a plastic * * *-like foreign body from her. She admits to using * * * 1 ~ 2 every week? Second; Another example is 69? There is a glass in a 10-year-old woman's * *. A few years ago, her husband could not replace it with a glass. Afterwards, the couple failed to take it out, and her husband forbade her to seek medical treatment. It was not until her husband died that she went to see a doctor. After cutting, she couldn't take out the glass completely, so she had to take it out one by one.
5. Foreign bodies invade the reproductive tract from other parts.
10 diagnostic examination and diagnosis: the basis of diagnosis;
1. There is a history of foreign bodies being inserted, or a history of suspicious foreign bodies.
2. The clinical manifestations are increased secretion of * * * *, purulent, watery and smelly.
3.*** refers to the diagnosis of foreign bodies in * * *, and women with sexual history can make a diagnosis through * * * examination.
4. If necessary? Super, x? X-ray, CT? Wait for the auxiliary inspection.
5. Generally, there are no symptoms or signs of systemic infection.
6. Can local inflammation of reproductive tract be treated by secretion smear, culture or PCR? Waiting for diagnosis.
7. It is difficult to diagnose some small and soft nonmetallic foreign bodies in children, and foreign endoscopic diagnosis is useful. There is no special examination instrument for children in China, and nasal endoscope is often used instead.
Laboratory examination:
1.*** secretion smear? Look for trichomonas, candida and other pathogenic microorganisms to determine the type of infection. * * * foreign bodies are easy to be infected, and smear examination of * * * secretion is helpful for diagnosis and treatment.
2.*** exfoliative cytology? Assist in the diagnosis of inflammatory reaction, and exclude malignant tumors, such as infant cervix and staphyloma.
3. Methylene blue test? The purpose is to distinguish bladder fistula, cervical fistula or ureteral fistula, and to help identify tiny fistula with unknown location. The method is to mix 200ml? Diluted methylene blue solution is injected into the bladder through urethra. If the blue liquid overflows through the small hole in the bladder wall, it is a bladder fistula. Bladder-cervical fistula is caused by the outflow of blue liquid through the external cervix; Clear urine flows from * * *, indicating that urine comes from the kidney and belongs to ureteral fistula.
Other auxiliary inspections:
1.x？ X-ray examination can sometimes see opaque shadows according to the nature of foreign bodies.
2. Cystoscopy? You can know the situation in the bladder, whether there are stones, inflammation, especially the location and quantity of urine leakage.
3.*** lavage? Often used in * * * or girls, * * * lavage can not only improve the * * * environment, but also be beneficial to the treatment of * * * inflammation, and small foreign bodies can also be washed out to make a definite diagnosis. From 1996 to 2000, the clinical reports of pediatrics and adolescent gynecology in the University of Michigan were reviewed. Abnormal drainage before puberty was 3 1 case, with an average age of 6? Years old, * * * Drainage duration 13? Month (1 ~ 42? Month) in which 15? Cases that need to exclude * * * foreign bodies account for 52%, 7? There were 2 cases of lavage? A foreign body was found in the case. 10? There is no abnormality in routine microscopic examination, and the author thinks that * * * lavage can be used as a routine method to remove * * * foreign bodies.
4. intravenous pyelography? After intravenous injection of 76% meglumine diatrizoate, at 515,30,45 minutes? X-ray examination to find out whether there is abnormality in bilateral renal function and ureter is used for the diagnosis of ureteral fistula.
Differential diagnosis of 1 1. * * * inflammation
2. cervicitis
3.*** ascaris infection
4. Malignant tumor of reproductive system
12 treatment plan * * * is an elastic muscle cavity, the upper end is wider than the lower end, and the mucosa of * * * has many lateral folds, and the front and rear walls are close together at ordinary times, so once foreign bodies enter * * *, it is difficult to fall off by themselves.
1. The method of taking out the foreign body is slightly different depending on the patient's age and the size, position and shape of the foreign body.
(1) Press * * * to take out: older children can put their fingers into * * to hook out the foreign objects, or use a small speculum to clamp the foreign objects with tweezers, and adults can clamp the foreign objects directly under the speculum. Emge？ It is reported that a foreign body, an orange, was successfully taken out with tweezers. When taking a sharp foreign body, the long axis of the foreign body should be parallel to the longitudinal axis of * * *, and the tip of the foreign body should face the mouth of * * * to prevent damage to mucosal tissue.
(2) Anal examination pushing method: Children can push out foreign objects with hemostatic forceps or a small curette under the guidance of anal examination fingers.
(3) Nasal endoscope: dilate children with nasal endoscope, and clamp foreign bodies with tweezers. If the child cannot cooperate, ketamine intravenous anesthesia is feasible. The stems and leaves of the nasal endoscope are about 3cm long and can reach the lower segment of * * *. Under the topical anesthesia of 1% tetracaine, the nasal endoscope was expanded, and then the foreign body was taken out with a small curette or oval forceps. Simple and convenient, no damage, easy to popularize and use in primary hospitals.
(4) Taking out foreign bodies under hysteroscopy: Because the nasal endoscope is short and there is no light source, it is sometimes difficult to achieve the purpose of diagnosis and treatment. It is reported that it is useful to take out foreign bodies under hysteroscopy: local mucosal anesthesia is needed during the operation, and 1% tetracaine cotton pad is applied to the mouth for 5 minutes? After that, we will have a microscopic examination. Take the lithotomy position of bladder, disinfect vulva routinely, and use 500ml of 5% glucose solution? Gentamicin 16? Wan u? Flush the vulva. Apply lubricant to the hysteroscope, slowly insert * * *, and then press the vulva on the cotton ball with the thumb and forefinger of the left hand to prevent the liquid from flowing out and expand * * *. The pathological changes were observed comprehensively under hysteroscopy, and necessary treatment was carried out according to the condition, such as taking foreign body, biopsy, washing and medication.
(5) Microscope: Parker? In 2000? Where is the small diameter trocar? Small foreign bodies, such as colored crayons, can be found by using sheath tube, 2 ~ 3 mm endoscope and normal saline as uterine dilating fluid, which can be treated under direct vision and used for the diagnosis and treatment of pre-adolescent children's diseases, with simple operation, little damage and easy acceptance.
(6) *** Flushing: The catheter can be inserted into the catheter and washed repeatedly with 40% Arnebia oil under pressure. Sometimes small foreign bodies such as gravel and wheat grains can be washed away by washing liquid, which has anti-inflammatory effect.
2. local treatment? After the foreign matter is taken out, it should be treated as * * *, and washed with 0.5%~l% ~ L% acetic acid solution, or 1/5000? Rinse with potassium permanganate solution, scrub with 5% iodophor, or apply erythromycin ointment locally. Suspicious leeches burrow into * * *, and often only see * * * mucosal congestion and small bleeding spots, which can be treated with erythromycin ointment and oral anti-inflammatory drugs. If it is inflammatory bleeding or trichomonas is detected in the laboratory, metronidazole (metronidazole) 0.2g? Dissolve in *** 1? Time /d, with 7? Jesus Christ. Patients with other specific inflammations should be treated according to the corresponding treatment principles. A few * * * side walls have polyps, which should be taken out for pathological examination. Pathological examination showed that it was * * * grape swelling, which required chemotherapy and radical surgery.
3.*** Surgical repair? Anyone with urinary fistula or fecal fistula needs surgical repair. The principles of surgical repair are as follows:
(1) Generally, it takes 3 ~ 6? Next month, after the inflammation subsided, the scar softened and the local blood supply returned to normal, the operation was performed.
(2) If there are stones with inflammation in the bladder, the stones should be removed and repaired after the inflammation is controlled.
(3) For those with regular menstrual cramps, it should be 3 to 7 days after menstruation. Surgery in a few days.
(4) Dexamethasone should be given before operation when necessary to promote scar softening.
(5) 3 ~ 5 years before operation? Daily use 1/5000? Potassium permanganate solution hip bath, fecal fistula repair before 3? Eat less residual diet, and take oral antibiotics norfloxacin or metronidazole to control intestinal bacteria.
(6) Is it necessary to leave a catheter after the repair of 7 ~14 urinary fistula? In order to ensure the continuous smooth drainage of bladder and prevent urinary tract infection, opioid drugs were taken after fecal fistula repair, and the control was 4 ~ 5? Not defecation.
4.*** Adhesion separation? Foreign body staying in * * * for a long time can cause * * adhesion or partial * * * atresia, and should be separated by surgery. Le? SQ？ Sign up for 2 1? A 15-year-old female complained of * * * difficulties and foul secretions. In 2000 and 2000, I sought medical advice from various sources. It was found that there was a tender mass in the posterior fornix, annular granulation tissue hyperplasia in the middle section, and a small hole in the top of the naked eye tissue to discharge purulent secretions. * * * Ultrasound confirmed that the posterior fornix was 5.4cm×5.0cm×5. 1cm? Mixed mass; Try injecting contrast agent from this hole, showing the outline of a cylindrical object inside * * *, but there is no uterus or fallopian tube. Pelvic MRI? Hint -3.8cm×2.8cm? There is viscous liquid and soft tissue around the cup-shaped object, which determines that the abnormal vault is formed by the proliferation of foreign bodies and granulation tissue around foreign bodies. Then open the dilated fistula, discharge a lot of malodorous secretions, and separate the surrounding proliferative tissues. Take out the plastic bottle cap (3.2cm×2.2cm) buried deeply in it, remove the redundant scar tissue, and widen and deepen the top of * * *. After the operation, place the mold to prevent adhesion again. The patient doesn't remember any foreign bodies. * * * Long-term granulation tissue hyperplasia around the upper end, forming a fistula-like hole like the external cervix, which is difficult to diagnose. Need to use pelvic MRI and other auxiliary examinations. Wait a minute.
5. exploratory laparotomy? Most of the complications caused by * * * foreign bodies can be solved by * * * surgery, and a few of them need laparotomy, such as pelvic abscess, broad ligament abscess and ureteral fistula caused by * * * foreign bodies. , or foreign bodies left at the top of * * * during open surgery. Hemelt? A 70-point report 1 case 1 year-old female underwent abdominal sacrum fixation due to prolapse, and reported chronic pelvic pain and massive drainage after operation. Pelvic radiography showed that there was a "needle-like" substance at the broken end of * * *, that is, laparotomy was performed to explore foreign bodies, and a short medical cotton swab was found at the broken end of * * * due to negligence. Beanstock? It is reported that the patient has a 4cm internal cavity. The hard object taken out under general anesthesia is a layer of aerosol deodorant. Because the patient was complicated with ureteral fistula, bladder fistula and rectal fistula at the same time, laparotomy was performed, ureterovesical anastomosis, bladder fistula repair and wall repair were performed.
6. Treating toxic shock syndrome? Intensive supportive treatment is the key to successful rescue.
(1) At the beginning, add fluids and electrolytes, monitor central venous pressure, pulmonary wedge pressure and urine volume, and guide treatment.
(2) Conduct laboratory examination and pathogen culture as soon as possible.
(3) Dopamine can be used when blood pressure is too low; Naloxone can correct hypotension by antagonizing the effect of endorphins. If adult respiratory distress syndrome occurs, mechanical ventilation is needed; When renal failure occurs, hemodialysis is needed.
(4) Early application of glucocorticoid after diagnosis can reduce the harm of the disease and shorten the course of fever.
(5) Although Staphylococcus aureus does not exist in the blood circulation, β -lactamase resistant antibiotics such as naxacillin (ethoxynaphthalene penicillin), oxacillin (oxacillin) or methicillin (methicillin) should be used by intravenous drip or intramuscular injection, and if allergic to penicillin, vancomycin 500mg can be used instead. When kidney injury occurs, the dose must be reduced.
13 complications The most common complications are:
1.*** Fistula
2. Transfer to an adjacent organ? Entering the bladder can form bladder stones; Or penetrate the vault and enter the pelvic cavity, forming pelvic foreign bodies, broad ligament foreign bodies and so on.
3. Pelvic infection and abscess formation
4.*** Adhesion and partial * * * atresia
5. Scar of cervix
6. Toxic shock syndrome (toxic shock syndrome? Shocked? syndrome
14 prognosis and preventive prognosis: the mortality rate of patients with toxic shock is 3% ~ 6%.
Prevention: For patients with bleeding, increased secretion, foreign body sensation, urgency and pain in urination, especially * * *, we should carefully identify the causes, actively treat them and prevent complications.
15 epidemiology * * * foreign bodies are not uncommon in clinic. * * * Foreign bodies can occur at any age, are common in China, and can also be seen in mentally ill adults. Normal adult women in foreign countries also happen from time to time.
16 especially suggests that patients with bleeding, increased secretion, foreign body sensation, urgency and pain in urine, especially * * *, should carefully identify the causes, actively treat them and prevent complications.
Acupoint bladder for treating foreign body