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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.
Every operation, and delivery by caesarean section is no exception, ends with a suture. The purpose of incision processing 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 is formed around the threads, an abscess is formed with purulent fusion of tissues. The generally accepted requirements for the antisepsis of the surgical material and the surgical field require careful processing 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, which tightens 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. The ligature fistula may be the only one, or pus erupts in several areas of the surgical suture.
The time of formation of such a complication ranges from 2-3 days to several months. When the intensity of inflammation decreases, the ligature fistula may spontaneously close for a while, but the final recovery does not occur until the source of suppuration is removed.
Causes of appearance
For the appearance of a fistula after a caesarean section, there must be predisposing factors.
Common causes of the formation of a ligature fistula:
Infected suture material;
Infection of the surgical field;
Low quality ligature;
Violation of the rules of antisepsis during and after the operation;
Incorrect processing of the surgical suture;
Low immunity.
The loads associated with pregnancy and childbirth, a stress factor, weaken the 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
With the formation of a fistula on the seam left after a caesarean section, immediate action is required, 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. With a fistula rupture, 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 reaction of the body to the formation of a purulent focus and the accompanying high temperature, negatively affects the functioning of most organs;
The appearance of phlegmon – the spread of inflammation in the subcutaneous fatty tissue;
Prolapse of abdominal organs from a molten wound.
Complications can be prevented only by timely diagnosis of the ligature fistula.
Symptoms
Women who have undergone a caesarean section should be aware of 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 seal;
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, temperature values uXNUMXbuXNUMXbmay be close to normal, but still increase. The more the inflammatory process develops, the more pronounced hyperthermia.
Diagnostics
Not all women can independently detect the onset of the inflammatory process in time. Usually the patient goes to the doctor when the infection of the wound has gone too far. If the wound after caesarean 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 granulated tissues;
Studying the anamnesis, complaints of the patient;
Probing of the ligature fistula to determine the parameters of the defect;
Ultrasound with contrast;
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 for the surgical thread to come out on its own. Only in the conditions of a surgical hospital is it possible to prevent the spread of infection, open suppuration and remove the fistula.
Operative therapy
There are two tactics for the surgical treatment of a ligature fistula – the doctor removes the thread that caused the inflammation, or excised the entire fistula, which is preferable in many cases. The thread is removed 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 inflammation, the fistula is finally tightened. If there are recurrences, the operation is repeated.
A wide incision is not made, because there is a risk of cellulitis and the 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 preparations, 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 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 performed under local anesthesia, with careful observance of the rules of antiseptics. After removal of the fistula, the wound is sutured, its condition is controlled for 5 days. After the site of excision of the fistula has healed, the sutures 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 in the entire area of the wound. Treatments are often carried out to effectively remove pus and disinfect the suture site.
If in this way it is possible to stop the inflammation, the ligature fistula may be delayed spontaneously. To support immunity, immunostimulants and vitamin complexes are prescribed. A course of antibiotics will help keep the infection from spreading. 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 observance of the rules of antiseptics during cesarean section, there remains a risk of a ligature fistula. It is impossible to predict in advance whether a woman will experience a rejection of the suture material or not. However, preventive measures can help prevent complications.
Preventive measures:
Rational management of caesarean section;
Compliance with the rules of antiseptics;
Careful preparation of the operating field;
Use of modern surgical materials.
To prevent the development of inflammation of the suture after cesarean section, you need to carefully monitor its condition for several months after the operation.