An abscess translated from Latin means "abscess". In medicine, this term refers to a limited accumulation of purulent exudate in tissues and organs. Purulent inflammation can occur anywhere. Soft tissue abscess is a space filled with purulent exudate and located under the skin in fatty tissue or muscles. The disease is characterized by swelling, redness and soreness of the skin.
The concept of abscess
An abscess or abscess is a purulent-inflammatory disease characterized by biological destruction of the tissue and the formation of a purulent cavity in it. Purulent-inflammatory disease can occur as an independent or be a complication of any pathologies.
An abscess can occur in the muscles, subcutaneous tissue, bones, organs, or between them. Depending on the localization, paratonsillar, pharyngeal, appendicular, soft tissue abscesses are distinguished, etc. More often the infection is exogenous (the pathogen penetrates from the outside), but there are cases of endogenous infection. The causative agent can get from both nearby and distant organs.
Soft tissue abscess
The disease is quite common. According to some reports, about 14 million patients seek medical attention annually.
The main difference between soft tissue abscesses (photo below) is the presence of a capsule (pyogenic membrane). Such capsules are inherent in abscesses of any localization, even for those that appear in the internal organs. The pyogenic membrane of soft tissue abscesses plays a very important role - it prevents the spread of the purulent-inflammatory process to nearby anatomical structures. However, an excess of exudate can lead to thinning of the capsule with its subsequent rupture and the release of purulent contents into the surrounding spaces.
Another plus of abscesses of soft tissues is their localization. The abscesses are on the surface, which contributes to the most accurate diagnosis with the appointment of adequate therapy.
According to ICD-10, an abscess of soft tissues has the code L02. Boils and furuncles are also included. International standards classify the disease as soft tissue and skin infections.
Abscess and infiltration - what is the difference?
When injuring the skin due to surgery or inflammatory pathologies, complications arise. An infection enters the body and an abscess and infiltrate form. The latter is an accumulation of cellular elements in the tissue mixed with blood and lymph.
Despite the general etiology and pathological anatomy, these are two different pathological processes. Soft tissue abscess from infiltrate differs in the following:
- The presence of fluid in a closed cavity. With an abscess, the fluid is a purulent exudate, with an infiltrate there is no cavity at all, the tissue is saturated with decay products of the inflammatory process.
- Infiltrate can arise from tumor cells, and an abscess is caused only by pathogenic microorganisms.
- Infiltrate can lead to the formation of an abscess, but on the contrary it does not happen.
Classification of abscesses
Soft tissue abscesses are classified differently. The main is considered etiotropic systematization:
- Simple - monomicrobial with localized clinical data. The main pathogens are staphylococcus (usually golden) and beta-hemolytic streptococcus. Most often they are small, located on the surface and are easy to treat
- Complex - can be mono - or polymicrobial. The causative agent is staphylococcus in association with Escherichia coli, Proteus and other microorganisms, mainly anaerobic. Complex penetrate deep into the tissue, follicles. According to ICD-10, soft tissue abscesses and boils are combined into one category and have a common code.
Classification by the nature of the course:
- Acute, characterized by a small focus of inflammation and a single-layer capsule. In the early stages of inflammation, the walls of the capsule are covered with purulent-fibrous deposits and particles of molten tissue.
- A chronic abscess is characterized by a severe course with extensive general toxic symptoms. A bilayer pyogenic membrane is formed. The inner layer consists of granulations and faces the cavity; the outer layer consists of mature connective tissue.
The following abscesses are distinguished into separate groups:
- Cold - accumulation of pus in a small limited cavity, without any manifestations of the inflammatory process (redness, soreness, fever). Such an infection is endogenous and occurs with tuberculosis or actinomycosis.
- Necal abscess is almost asymptomatic. It can develop within a few months without signs characteristic of the inflammatory process. The danger is that people do not attach importance to such an abscess and do not engage in therapy. Meanwhile, he goes into a chronic form.
Causes of subcutaneous abscess
The main reason for the formation of an abscess is the ingestion of pathogenic microflora into the body. Most often, the causative agent of infection is staphylococcus, but crops determine the presence of other microorganisms:
- Epidermal, hemolytic, Staphylococcus aureus.
- Staphylococci, beta-hemolytic are most often determined, pneumococcal are also found. The latter are characteristic of complicated endogenous abscesses.
- Gram-negative bacteria: E. coli.
- Proteus. The habitat of this type of enterobacteria is soil and water. The pathogen enters the body, as a rule, through a dirty reservoir.
- Pseudomonas aeruginosa is highly antibiotic resistant. It is the causative agent of nosocomial (nosocomial) infections.
- Klebsiella are found on the skin, mucous membranes. The impetus for their biological activity is given by a weakened immune system.
- Shigels. The carrier and source of infection is a sick person.
- Koch's wand.
It is possible to determine the causative agent of soft tissue abscess by purulent contents, more precisely by its nature (smell, color). Experienced doctors on these characteristics make a preliminary diagnosis.
- Putrefactive microflora (E. coli) are characterized by gray color and fetid odor.
- If the causative agent of staphylococcus is a yellow-green purulent exudate.
- The sweet smell and blue-green color of the exudate is characteristic of Pseudomonas aeruginosa.
Pyogenic microbes most often enter the body in violation of the integrity of the skin (wounds, scratches). A purulent process can occur when bacteria spread by the lymphogenous or hematogenous route from existing foci of inflammation.
Often a purulent-inflammatory disease is formed against the background of other protracted infections. Chronic tonsillitis, sinusitis contributes to the development of soft tissue abscess. A special role in the development of ulcers is diabetes.
The pathogenesis of purulent-inflammatory disease
An abscess occurs either in necrotic tissues, where autolysis processes occur (self-dissolution of cells under the influence of enzymes), or in living tissues susceptible to aggressive effects of pathogenic microorganisms.
When an infection enters the body, immunity is activated. The main "defenders" are white blood cells (neurophilic, basophilic). 6-8 hours after the introduction of the infectious agent, neurophiles from the vascular bed pass into the mucous membranes. With the help of chemoattractants, neurophilic white blood cells penetrate the inflamed area.
In the initial stage of the purulent process, the affected area is infiltrated (impregnated) with inflammatory fluid and white blood cells. Over time, under the influence of neutrophil enzymes, the tissue undergoes fusion, and an internal space filled with exudate is formed. Pus in the cavity is a lysosomal enzyme of neurophilic residues. The walls of the soft tissue abscess eventually form a bilayer pyogenic membrane. It does not allow exudate to spread to neighboring anatomical structures.
Clinical manifestations of an abscess
The general symptoms of abscesses are the same as with any inflammatory processes accompanied by the formation of pus. The severity of clinical manifestations is determined by several factors:
- Human condition. People have a heterogeneous susceptibility to various pathogenic agents, the reaction can manifest itself in different ways.
- The toxicity of an infectious agent. Some types of bacteria, even in very small quantities, can cause severe inflammatory processes.
- Extensive inflammation.
- The prevalence of necrotic changes.
With abscesses, both local and somatic symptoms are observed.
- Hyperemia at the site of inflammation.
- Slight swelling.
- Fever in the abscess.
- Painful sensations.
- With deep necrotic changes, a general malaise is observed, an increase in body temperature to 40 ° C with chills.
With tuberculous etiology, a purulent-inflammatory process spreads far from the place of occurrence. For example, sagging abscess of the soft tissues of the thigh (mainly on the medial surface) may occur.
Large abscesses that arise on the surface of the skin of the limbs affect their functionality. When walking or moving hands, pain occurs, which dramatically limits motor activity.
An abscess of the soft tissues of the buttocks resulting from intramuscular administration of drugs is usually accompanied by severe pain. The inflamed area can take on a burgundy or even blue hue. The formation of a hematoma prevents the capsule from breaking out and creates the risk of sepsis.
What is the likelihood of complications?
In severe course of purulent-inflammatory process with predominant intoxication, problems arise in finding out the causes of the patient’s serious condition. There may be several reasons for this condition:
- Purulent-resorptive fever - absorption of toxic decomposition products into the blood from the focus of inflammation. With a significant accumulation of pus, it penetrates through the membrane. Absorption occurs by the lymphogenous and hematogenous routes.
- Generalization of infection or sepsis is a common purulent infection caused by pathogens and their toxins entering the circulating blood. The infection is characterized by intoxication, thrombohemorrhagic syndromes, metastatic tissue damage.
- Another complication of soft tissue abscess is phlegmon. The purulent process tends to spread. Phlegmon is characterized by general malaise, fever, soreness of the affected area when moving or feeling.
- Neuritis can occur due to purulent fusion of the wall of a large vessel and the nerve trunk located in it.
- Osteomyelitis. When the purulent process spreads to the bones, bone marrow inflammation can develop.
Diagnostics
A purulent surgeon is involved in a physical examination, an anamnesis, and the appointment of diagnostic measures. When conducting a survey, the doctor draws attention to the presence of infections, the appearance of inflammation after injuries, surgeries, injections.
During a physical examination, the doctor determines the following:
- During the examination, swelling of the tissues and redness of the skin in the abscess area are observed. The temperature at the site of inflammation is much higher. The skin on the surface of the purulent formation is greatly thinned, exudate is visible through it.
- On palpation, an elevation is felt at the site of inflammation, the patient experiences pain when palpating. When you click on the purulent focus, characteristic waves are noted - fluctuation.
Diagnostic measures include laboratory tests:
- The microscopic research method allows us to study the morphological and tinctorial properties of microbes.
- Bacterial sowing. With its help, the pathogen and its resistance to antibacterial drugs are determined.
- Clinical blood test.
- If tuberculosis is suspected, a Mantoux test is done.
Instrumental diagnostic methods:
- An ultrasound of the soft tissue abscess allows you to study deep and necrotic abscesses.
- Diagnostic puncture is performed for the same purpose as sonography.
- An X-ray examination is prescribed for suspected tuberculosis.
Differential diagnosis of subcutaneous abscess
The clinical manifestations of abscesses have much in common with some pathological conditions. Differential diagnosis allows not only to confirm the diagnosis, but also to determine the nature of inflammation, the depth of the pyogenic membrane, and the presence of necrotic tissues. Diagnostics includes sonography, laboratory tests and other research methods, the abscess must be differentiated from:
- Infiltrate.
- Decaying tumor. Under the influence of decay products, severe intoxication occurs with characteristic symptoms also characteristic of the abscess.
- Foreign body. An abscess of soft tissues on an ultrasound scan looks like a dark accumulation of fluid with gray contents inside, while a foreign body has a characteristic appearance, small pieces of glass may not be visible at all.
Soft tissue abscess treatment
Therapy is determined depending on the course of the purulent process, the patient's well-being. In the initial stages, conservative therapy is prescribed. Its main task is to cause spontaneous external breakthrough of the capsule. Apply thermal compresses, apply a heating pad. Prescribe anti-inflammatory drugs ("Demiksid", ointment "Biopin") and UHF therapy.
In most cases, patients turn to the later stages of purulent-inflammatory disease, when conservative treatment of soft tissue abscess is ineffective. Such ulcers are subject to surgical treatment. An autopsy and drainage of the site of inflammation is usually carried out by a surgeon with a nurse in an outpatient operating room. Manipulation is performed using local anesthesia by soaking the tissues with novocaine 0.5% or intravenous anesthesia (Epontol, Sodium Thiopental). Dissection is carried out along the entire length of the abscess, so that a free outflow of exudate is ensured. The opened cavity is washed with an antiseptic solution until absolute cleansing and elimination of anesthetized tissue. For postoperative incision, a polyvinyl chloride tube, turunds with saline are inserted into the abscess cavity.
With deep abscesses through a small incision, the inner wall is cleaned with the contents aspirated, the cavity is drained with washing and active aspiration.
The use of antibiotics for soft tissue abscesses is prescribed if, after surgical treatment, intoxication symptoms do not subside. The use of antibacterial drugs is advisable in cases of suspected generalization of infection or purulent-resorptive fever.
Preventative measures
Abscesses are a rather dangerous disease. A breakthrough of the pyogenic membrane with the release of purulent exudate into the internal spaces threatens with severe intoxication. The etiology of the disease is well studied, which allows you to take measures to prevent it. Preventive measures are not specific and are not much different from antiseptic rules.
- Timely and complete treatment of wounds.
- In case of burns, frostbite, the therapy should be carried out by a doctor and monitor the process until complete recovery.
- Compliance with the rules of antiseptics for injections and other medical procedures.
- Adequate treatment of any diseases of infectious genesis.
- In case of suspicious abscesses, consult a doctor immediately.
Abscess monitoring
With timely treatment and the appointment of adequate therapy, the prognosis for recovery is favorable. As they recover, unpleasant symptoms are eliminated, patients return to their usual lives. The use of antibiotics for soft tissue abscesses can cause intestinal microflora disturbances. To recover, you should take a course of probiotics. Otherwise, pathogens can again cause infection.