Why do fistulas form at sutures? Pus from the suture after surgery. What is a fistula after surgery, what does it look like? Ligature fistula of a postoperative scar, fistula on a suture after childbirth, cesarean section, appendicitis: signs, causes, treatment, excision

Fistula after cesarean section is one of the most common problems, which is directly related to the operation and is dangerous because it provokes the entry of various pathological microorganisms into the female body, which stimulate the development of infectious processes.

After any operation, special sutures are applied to promote rapid healing. Doctors process the incision to stop the bleeding in time and prevent massive blood loss. The material of all seams is ligature. It does not cause women any further complications.

Before stitching a cut, experienced specialists carefully treat it to prevent bacteria from getting inside. If you do not do this, inflammatory processes will develop, which will provoke the appearance of a fistula. Any penetration into the suture material causes the formation of pus. It subsequently flows out, the passage is called a fistula. The fluid can make its way into one hole or into several, so many ligature fistulas can appear simultaneously.

Photos of fistulas after cesarean

The complication develops within 4 days after a cesarean section, up to several months. When the inflammatory processes pass, the fistulas close for a while, but recovery will not occur until doctors eliminate the source of suppuration.

Definition of fistula

A fistula is an opening in the form of a passage connecting certain openings in the body, organ systems with each other or with the environment. It looks like a narrow slit, which is lined with fabric. Fistulas are formed as a result of suturing after operations, as well as due to inflammatory processes occurring inside the human body.

Purulent fluid is formed due to the cessation of inflammatory processes. The hole through which this fluid flows out then heals completely. But if the infection is not completely suppressed, this canal does not heal and a purulent fistula is formed. Fistulas often form, which directly proves the development of pathological microorganisms inside a person. Any neoplasm is nothing more than the body’s reaction to the development and reproduction of these pathogens. If fistulas are detected, you should immediately seek the help of experienced specialists to carry out the necessary diagnostic measures and recommend how to properly treat this disease.

Important! Self-medication is not recommended, it can harm your health.

Causes of ligature fistula

A ligature fistula forms after a cesarean section for a number of reasons. These are often:

infections entering the body through sutures;
insufficient treatment of the cut;
violation of antiseptic rules during surgical procedures;
the appearance of allergic reactions to special materials used to stitch the wound;
age limits;
general condition of the woman;
immunity;
presence of chronic diseases;
the formation of inflammatory processes associated with seasonal diseases;
bad equipment;
consequences after cancer;
lack of useful minerals in the body;
presence of diabetes mellitus;
excess weight;
metabolic disorder syndrome;
inflammation in the oral cavity.

Fistulas often appear due to postoperative scars. Unsanitary conditions, enormous physical activity, stressful situations, the use of expired patches and bandages, poor diet and bad habits also have a beneficial effect on the development of purulent fistulas. If treated immediately, further complications may develop that will affect the woman's health and performance.

Symptoms of fistula after cesarean section

Signs of a fistula on the suture after cesarean section are the following:

in the first days there is a sharp thickening of the suture area and its redness. Doctors may observe slight swelling and a slight increase in body temperature;
after 7 days, liquid emerges from the sutures with strong pressure and palpation, and subsequently a purulent compound;
on the 10th day a febrile state appears, body temperature increases to 38°;
fistula canals become clogged on their own, but when inflammatory processes occur, they open again;
the appearance of a hole in the skin;
hot area around the seam.

Fistula openings are always accompanied by the appearance of a slight temperature. At the earliest stages this rise is insignificant, but This condition cannot be ignored; it is better to consult a doctor immediately to start treatment on time. It is very difficult not to notice a fistula, all symptoms quickly appear, and recognizing a neoplasm is quite simple. Typically, after a caesarean section, the doctor often examines the patient and observes how the stitches are healing, so he will very quickly detect infection and the development of inflammatory foci.

Treatment of ligature fistula

Before starting treatment, every woman should understand that getting rid of a ligature fistula can only be done through surgery. Prolonged delay in treatment can lead to a number of complications. Treatment includes taking the following medications:

Antiseptic agents with local anesthetic effect.
ampicillin group.
Enzymes that can quickly dissolve dead cells.

These medications need to be introduced into the fistula canal and peripheral places at certain intervals, because their effect lasts for 5 hours.

It is important to know that if there is a strong discharge of purulent fluid from the fistula, it is forbidden to treat the incision with greasy ointments, because they clog the passage of the canal, which contributes to the further spread of infection.

If the inflammatory process is severe, you can resort to other treatment methods - physiotherapeutic procedures. Experienced specialists recommend quartz wound. The procedure helps reduce swelling and improve the patient's condition. But such measures can only stop the development of the disease, cure it completely - in no case. Only with the help of surgical intervention can you get rid of the cause of constant suppuration. This disease cannot be treated at home.

Attention! Before taking any medications, consult your doctor!

Preventive actions

Doctors cannot guarantee 100% safety during and after surgery. Many infections penetrate inside quickly and deftly, so there are no exact preventive measures. But experts advise adhering to the following rules:

you need to stop using thick silk threads to stitch the incision;
after a cesarean section, use only synthetic threads;
strictly follow aseptic measures;
For speedy healing, take medications prescribed by your doctor.

To prevent the appearance of a fistula, you should properly care for the sutures, do dressings on time, take medications, lead a healthy lifestyle and eat right. Any deviations from the norm can provoke the development of pathology, even the appearance of diseases that are in no way related to gynecology and the urinary system: problems with the heart vessels, the gastrointestinal tract system and mucous membranes.

What do doctors think?

No doctor can fully guarantee that the operation will not lead to adverse consequences. Ligature fistulas appear due to the penetration of infectious microorganisms into the incision. Experts recommend immediately combating the pathology, because it can provoke the development of further complications and lead to sepsis. Therefore, you should definitely consult a doctor if you have fistulas after a caesarean section. It is very easy to detect; doctors advise paying attention if a seal appears around the wound and infiltrate.

All seals become hot, because this is due to the infection process. Redness will always be visible near the scar, at first small, then huge. During surgical interventions, the wound often festers and all its contents come out. It is also necessary to monitor the fact that these processes can provoke the appearance of swelling of peripheral tissues. Experts recommend not remaining silent about the development of fistulas, because they require immediate treatment. Surgeons may decide to operate again to completely cure the woman. To do this, they will use only thin surgical threads made of synthetics.

Conclusion

Fistula after cesarean section requires mandatory treatment. The patient is obliged to contact a specialist in a timely manner so that he can prescribe a number of necessary examinations and tests. Only an experienced specialist can prescribe treatment; all preventive and diagnostic measures are carried out only in a hospital. Treatment can be conservative or surgical. Most often, fistulas are removed surgically, after which the woman is prescribed antibiotics. The wound always requires special careful care. For this purpose, formulations are purchased; they help cleanse the wound of purulent fluid and avoid subsequent infection. Doctors recommend the use of hydrogen peroxide and furatsilin.

Conservative therapy helps when the process of fistula development has just begun. Doctors are trying to remove dead tissue around the inflammatory focus and completely wash out the pus. Often those threads that come out and provoke the growth of fistulas are removed. After getting rid of pathology The patient is prescribed a course of antibiotic therapy and complex vitamins.

To avoid ligature fistula, it is important to properly lubricate the wound, both before and after suturing. Doctors are required to work only with sterile materials. When the first signs of pathology appear, they must provide timely medical assistance. In most cases, the outcome of the disease is favorable.

Fistula after surgery It is very easy to recognize, therefore, as soon as the patient notices it, he should immediately tell his doctor about it. Such a wound will not heal on its own, so you should not wait and hope that it will heal on its own!

A fistula after surgery may appear for some reason; using a probe, doctors can determine the length of the fistula, and also its connection with the organs inside the body. If the fistula is labiform, then most often the problem is solved by surgical treatment. Other types of treatment have no prospects in this situation.

The fistula can also be tubular. It happens that it closes on its own. But this can only happen if the discharge has stopped.

If it is a pancreatic fistula, then it can be closed using radiotherapy.

There are also purulent fistulas, to get rid of them it is necessary to remove the foreign body, because it is this that provokes the onset of the inflammatory process.

It happens that during examination a congenital fistula is discovered. Its appearance is associated with developmental defects.

If a postoperative fistula is detected, then it can be cured with a compress. Honey is applied to the cloth and applied to the sore spot. It will begin to heal. You can also apply a cabbage leaf in the same way.

Ligature fistulas occur very often. And they are, in fact, a very serious phenomenon. As a rule, its treatment requires new surgical intervention. Therefore, he needs to report the problem as quickly as possible.

Fistulas can be either granulating or epithelialized. Only a tubular fistula - granulating, which has not yet formed - can be treated using traditional methods or medication. The walls of such a fistula are covered not with epithelium, but with granulation tissue. The healing process, however, will be hampered by the fact that the tissue is constantly exposed to the secreted fluid. Therefore, granulations are destroyed by chemically active substances and enzymes. In addition, microbial toxins are also released. It is possible that such a fistula will heal on its own, but to do this it is necessary to stop the release of substances. Very it is also important to stop inflammation in the sore spot. Conservative methods are suitable for this. For example, this could be some kind of antibacterial agent or physical therapy. While performing the dressing, it is necessary to clean the skin around the fistula, then treat it with sterile Vaseline and synthomycin emulsion. We must not forget about the discharge; while it is going on, it must be collected so that normal skin does not become inflamed either.

The appearance of a fistula on the body of a person who has recently undergone surgery is a kind of complication of the process of restoring damaged epithelial tissues, when the regeneration of their cells does not occur or occurs at a slow pace. Many factors influence such a pathological state of the operated area of the body, but in most cases it is the entry of infectious microorganisms into the wound that provoke a purulent-inflammatory process, as well as a severely weakened immune system of the patient.

A postoperative fistula is a through channel that is hollow inside and connects organs located in the peritoneum with the environment. Based on its etiology and symptoms, the pathology is considered extremely dangerous, as it prevents stable wound healing. This increases the likelihood that microbes, viruses and fungal infections will penetrate the internal organs, which can cause many secondary diseases of varying severity. After the operation, its formation is associated with the lack of normal dynamics of healing of the strip suture.

The very nature of the formation of a fistula is such that it is formed during the acute phase of inflammation, when purulent masses accumulated in the subcutaneous layer break through the epithelium, naturally drain and come out, creating a hole in the abdominal cavity or on any other part of the body. The most common fistula lesions in the abdominal cavity and lower extremities occur in medical practice. This is due to the physiological and anatomical structure of the human body.

Reasons for education

In modern surgery, it is generally accepted that prolonged non-healing of the wound surface formed after surgery is a complication that requires medication and sometimes even surgical treatment. For it to be effective, it is extremely important to establish the factor contributing to the development of the pathological condition of the suture. The following causes of postoperative fistulas of varying localization and severity are identified:

improper care of the wound, lack of antiseptic treatment with solutions specially designed for this (Chlorhexidine, Miramistin, Hydrogen Peroxide, Iodocerin), rare replacement of dressing material;
entry of pathogenic microflora directly at the time of the operation, if surgical instruments and threads that have undergone insufficient sterilization are used, or infection occurs during the rehabilitation process;
low-quality suture threads were used, which led to a negative reaction of the body and their rejection began with extensive inflammation and the formation of purulent masses;
reduced immune status of the patient, when the cells responsible for suppressing the activity of pathogenic microflora are not able to cope with the functional responsibility assigned to them and even non-dangerous strains of microorganisms enter the wound, leading to purulent damage to the epithelium with the formation of a hollow drainage canal (fistula);
excess body weight, when a thick layer of adipose tissue excludes normal regeneration of epithelial cells (the cut area of the body simply physically cannot heal, since the fat exerts constant static pressure on the wound);
senile age of the patient (patients who are already 80 years of age and older tolerate very poorly not only the surgical intervention itself, but also the period of recovery of the body, because the cells responsible for the formation of fibrous tissue, from which the suture scar is formed, divide at too slow a pace) ;
medical negligence and leaving surgical instruments in the abdominal cavity (such cases periodically occur in different countries of the world, and their occurrence is associated with insufficient care of medical personnel directly at the time of the operation).

By promptly eliminating these causative factors, it is possible to ensure stable recovery of the human body in the postoperative period, as well as to avoid the development of inflammatory processes.

How to treat a fistula after surgery?

The appearance of a postoperative channel through which purulent contents flow is not a death sentence for the patient. The main thing is to start treatment of the pathology in a timely manner so that the fistula does not cause the occurrence of concomitant diseases of an infectious nature. To do this, the patient is prescribed the following treatment measures.

Antibiotics

Washing the seam

The entire strip wound and the resulting fistula are subjected to daily cleansing with antiseptic solutions. Most often attributed to Hydrogen Peroxide with a concentration of 3%, Chlorhexidine, Miramistin, Iodocerin, manganese water. The procedure is performed 2-3 times a day to cleanse the tissues of purulent secretions and microbes.

Surgical debridement

Quite often, a fistula forms a scar consisting of fibrous tissue that is unable to grow together. This results in a hole that is no longer capable of healing on its own. To eliminate this pathology, the surgeon cuts off the edges of the fistula in order to start a new process of regeneration of exposed tissues.

Before surgery, antibiotics are used to ensure complete elimination of the infectious inflammation. IN otherwise the operation will only lead to an expansion of the diameter of the fistula. The described complex treatment of a non-healing wound ensures gradual healing of the inflamed wound with relief of the drainage channel.

The application of surgical sutures is the last stage of intracavitary surgery. The only exceptions are operations on purulent wounds, where it is necessary to ensure the outflow of contents and reduce inflammation in the surrounding tissues.

Sutures can be natural or synthetic, absorbable or non-absorbable. A severe inflammatory process at the site of the suture can lead to the release of pus from the incision.

The leakage of serous fluid, compaction and swelling of the tissues indicate such a pathological phenomenon as a ligature fistula of a postoperative scar.

Why does a ligature fistula appear after surgery?

A ligature is a thread for ligating blood vessels. By applying a suture, doctors try to stop bleeding and prevent its occurrence in the future. Ligature fistula is an inflammatory process at the site of wound suturing.

It develops due to the use of material contaminated with pathogens. The pathological element is surrounded by a granuloma - a compaction that consists of different tissues and cells:

The ligature thread is also part of the granuloma. Its suppuration is dangerous by the development of an abscess.

It is clear that the main reason for the formation of a ligature fistula lies in infection of the suture material. The development of an unfavorable process is provoked by various factors:

Avitaminosis.
Syphilis.
Tuberculosis.
General condition and age of the patient.
Hospital infection (streptococcus, staphylococcus).
Oncological diseases leading to protein depletion.
High immune reactivity of a young organism.
Rejection of the thread by the body due to individual intolerance to the material.
Wound infection due to lack of antiseptic treatment.
Metabolic disorders (diabetes, obesity).
Localization of the operated area (abdomen in women after cesarean section, paraproctitis).

Ligature fistulas occur in any part of the body and in all types of tissue. As for the time of their appearance, there are no exact forecasts. For some patients, the problem occurs after a week or a month, but it also happens that the fistula bothers you a year after surgery.

Symptoms of ligature fistula

The following symptoms help identify a fistula on a scar after surgery:

In the first days after surgery, the area thickens, swells, and causes pain when touched. The skin surrounding the wound turns red, and the local temperature rises.
After a week, when pressure is applied to the suture, serous fluid and pus are released.
Body temperature rises to 37.5 – 39°C.
The behavior of the fistula is unpredictable - the passage can spontaneously close and later reopen.

Only repeated surgery can help completely get rid of the canal. You can see what a ligature fistula looks like in the photo.

Externally, it is a deep wound with inflamed skin around the edges. Interestingly, a fistula can form completely different from where the incision was made. Doctors know of cases where inflammation developed for a long time inside the patient’s body, but the person himself realized that he was sick only when a small hole appeared on the body, from which purulent-serous fluid oozed.

A fistula is a hollow canal inside the body, a kind of link between organs and the external environment. It can also be a junction between the internal cavity and an oncological neoplasm. The canal, which looks like a tube, is lined with epithelium from the inside. Pus comes out through it. In advanced cases, bile, urine, and feces come out of the fistula.

Postoperative fistulas are divided into several types:

Full. Characterized by the presence of two outputs. This structure promotes rapid healing.
Incomplete. The fistula has one exit inside the abdominal cavity. Under such conditions, pathogenic flora rapidly multiplies and intensifies the inflammatory process.
Tubular. A properly designed canal releases purulent, mucous and fecal matter.
Lip-shaped. The fistula fuses with muscle and dermal tissue. It can only be removed through surgery.
Granulating. The fistula becomes overgrown with granulation tissue, the surface of the surrounding skin looks hyperemic and swollen.

In ICD-10, ligature fistula is listed under code L98.8.0.

Most often, ligature fistulas are formed in places where silk thread is applied. To avoid this problem, modern doctors use a material that does not require the removal of sutures and dissolves on its own after a short time.

Diagnosis and treatment of ligature fistula on a scar

Ligature fistula is diagnosed during examination of the postoperative wound. For a complete examination of the suspicious area, the patient is referred for ultrasound and fistulography. This is a kind of x-ray using a contrast agent. The image clearly shows the location of the fistula canal.

Treatment of ligature fistula requires an integrated approach. Patients are prescribed different groups of drugs:

Enzymes chymotrypsin and trypsin.
Antiseptics for local treatment.
SSD antibiotics – Norfloxacin, Ampicillin, Ceftriaxone, Levofloxacin.
Water-soluble ointments - Levomekol, Levosin, Trimistin.
Fine powders – Baneocin, Gentaxan, Tyrosur.

Enzymes and antiseptics are injected into the fistula canal and surrounding tissues. The substances act for 3 – 4 hours, so the problem area is treated several times a day. In case of profuse discharge of purulent masses, it is forbidden to use Vishnevsky's liniment and synthomycin ointment. They clog the canal and delay the outflow of pus.

In order to relieve inflammation, the patient is referred to physiotherapeutic procedures. Quartz treatment of the wound and UHF therapy improve microcirculation of blood and lymph, reduce swelling and neutralize pathogenic flora. The procedures provide stable remission, but do not contribute to complete recovery.

Complications of a ligature fistula: abscess, phlegmon, sepsis, toxic-resorptive fever and eventration - loss of organs due to purulent melting of tissue.

A non-closing ligature fistula is treated by surgical debridement of a complicated postoperative wound. The area is disinfected, numbed and incised to completely remove the suture material. The cause of the fistula is also excised together with adjacent tissues.

To stop bleeding, use an electrocoagulator or hydrogen peroxide (3%), otherwise suturing the vessel will provoke the formation of a new fistula. The surgeon’s work is completed by washing the wound with an antiseptic (Chlorhexidine, Decasan or 70% alcohol), applying a secondary suture and organizing drainage in the treated area.

In the postoperative period, the drainage is washed and the dressing is changed. For multiple purulent leaks, antibiotics are used, Diclofenac, Nimesil and ointments - methyluracil or Troxevasin. Minimally invasive methods of fistula removal, for example, through ultrasound, are ineffective.

It often happens that an infection that progresses inside seeks a way out. This especially happens after surgery. Let's look at why this happens and how the resulting fistula is treated after surgery.

Fistula - what is it?

A fistula is a canal that connects body cavities or hollow organs to each other or to the external environment. It is lined with epithelium, and through it pus comes out, or the canal is lined with granulation tissue. If this does not happen, then a purulent fistula forms.

Such a process may be the result of some inflammatory process in the body or a consequence of surgery.

Types of fistulas

Depending on where the fistula is located, they are divided into:

Gastric fistula.
Rectal.
Rectovaginal fistula.
Duodenal.
Bronchial.

The fistula can be complete or incomplete. A complete one has two holes and is treated faster, since it has a way out; an incomplete one, having one hole, further develops the inflammatory process, the number of bacteria increases.

The fistula can be labiform or tubular. Labial can only be treated with surgery.

If we consider the process of formation, then a granulating fistula is one that is not yet fully formed, while a tubular one is already lined with epithelium and is fully formed.

What are the reasons for the appearance of a fistula after surgery?

There are several reasons for this phenomenon:

The last point is the most common reason why a fistula appears after surgery. There are also several explanations for this:

Non-sterile suture material.
The body's reaction to a foreign body.

A fistula at the suture after surgery forms a compaction of the suture thread itself, fibrous tissue and collagen fibers.

How to recognize the appearance of a fistula after surgery?

Since this is primarily an inflammatory process, it is not difficult to recognize a fistula after surgery based on its characteristic symptoms. They are:

If you experience such symptoms, you need to see a doctor immediately, otherwise the infectious process may spread to your organs or cause blood poisoning.

Diagnosis of fistula

Diagnosing a fistula after surgery is not difficult, since it can be seen visually if it is external. The doctor, after listening to the patient and examining him, pays attention first of all to:

Quantity and quality of discharge.
The size of the fistula, its color.
If the fistula is interorgan, then pay attention to the work of neighboring organs, especially if there are changes.

In order to find out the length and direction of the fistula canal, probing and radiography are used.

It is also necessary to do a series of tests that will confirm the type of fistula. The gastric one will show the presence of hydrochloric acid, and the uric one will show the presence of uric acid salts.

It happens that the suture may begin to fester a long time after the operation, so you need to find out the reason for this phenomenon.

If a fistula does appear after surgery, how to treat it?

Treatment of fistulas

For successful therapy, it is first necessary to:

As a rule, the wound begins to heal. If this does not happen, then surgical intervention is possible, in which excess granulation is removed, and the areas can be cauterized.

The newest method is the treatment of fistula after surgery using ultrasound. This method is considered the most gentle, but it is not fast.

In severe cases, if several fistulas have formed, complete excision of the postoperative scar is indicated. The infected suture material is removed and a new suture is placed.

Postoperative intervention

If you still failed to cure the fistula and had to resort to surgical methods, then after the operation to remove the fistula, healing will take place within several weeks. The wound will heal faster if you provide it with complete rest and proper care.

After surgery for a rectal fistula, the doctor, as a rule, prescribes a diet so that the wound heals faster. After such operations, painkillers and antibiotics are required. The wound heals within a month; any physical activity is avoided.

The prognosis for treatment is usually good and the patient makes a full recovery.

Traditional methods of treatment

Of course, people always try to cure the disease at home. There are several recipes for treating fistulas with folk remedies. Here are some of them.

It is worth noting that if a fistula has formed after surgery, then treatment should be carried out under the supervision of doctors, and folk remedies are an addition to the main course.

Prevention of fistulas

In order to prevent fistulas from appearing after surgery, it is necessary:

First of all, observe the rules of asepsis during surgery.
All instruments and suture material must be sterile.
It is necessary to treat the wound before suturing it.
Vessel doping should occur with little tissue involvement.
Prescribe antibacterial drugs to prevent infections.
It is necessary to treat all infectious diseases, preventing the development of fistulas.