Download phlegmon

PHLEGMON
By– Dharmendra Singh
Group no. – 317
Phlegmon
 Phlegmon is a spreading diffuse inflammatory process
with formation of suppurative/purulent exudates or pus.
This is the result of acute purulent inflammation which is
due to bacterial infection.
 An example would be phlegmon of diverticulitis. In this
case a patient would present to the emergency
department with left lower quadrant abdominal
tenderness, and the diagnosis of sigmoid diverticulitis
would be high on the differential diagnosis, yet the best
test to confirm it would be CT scan.
Eyelid phlegmon
 Another example, phlegmon affecting the spine,
is known as spondyliktosis and is associated
with loss of disc height and endplate
destruction. In adults, the bone marrow is
affected first, while in children, the disease
starts in the disc itself and spreads rapidly to the
adjacent vertebral bodies. Phlegmon in the
spine can be a diffuse enhancement, or localized
abscess, (peripheral enhancement) in the
epidural, subligamentous or paraspinous spaces.
Under MRI examination, phlegmon will show
dark with T1, and high signal (bright) with T2
Etiology
 Commonly by bacteria - streptococci, spore and
non-spore forming anaerobes, etc.
 Factors affecting the development of
phlegmons are virulence of bacteria and
immunity strength.
Classification
 By clinical course:


acute
subacute
 By severity of condition:



mild
average
severe (with spreading to other location(s))
 By location:

Superficial





cutaneous
subcutaneous
interstitial tissue
intramuscular
Deep
 mediastinal
 retroperitoneal
 By etiology:
 single
 mix (eg:spore and non-spore forming anaerobes)
 By pathogenesis:
 per continuitatem (through neighbouring tissues)
 hematogenous (through non-valvular veins like
venous plexus of face eg: v. pterygoideus plexus →
inflammation of veins (phlebitis) → thrombus
formation in veins → embolization of thrombus into
sinus venousus systems)
 odontogenous
 By exudative character:
 purulent phlegmon
 purulent-hemorrhagic phlegmon
 putrefactive phlegmon
 By presence of complications:
 with complications (disturbance of mastication,
ingestion, speech, cardiovascular and respiratory
system, peritonitis, lymphadenitis, loss of conscious if
very severe, etc)
 without complication
Clinical Picture
 Systemic features of infection such as increased
body temperature (up to 38-40 °C), general
fatigue, chills, sweatings, headache, loss of
appetite).
 Inflammatory signs - dolor(localized pain),
calor(increase local tissue temperature), rubor
(skin redness/hyperemia), tumor (either clear or
non-clear bordered tissue swelling), functio
laesa (diminish affected function).
 NB: severity of patient condition with
phlegmons is directly proportional to the degree
of intoxication level i.e the severe the condition,
the higher degree of intoxication level.
 A noninfectious occurrence of phlegmon be
found in the acute pancreatitis of Systemic
Lupus Erythamatosis. The immunosuppressive
aspects of this disease and the
immunosuppressive medications used to treat it
blunt each of the signs of infection.
Diagnostics

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Complaints and clinical appearances
Anamnesis
Visual and Palpations
Blood test - leukocytosis (up to 10-12×109/L),
decrease or absence eosinophils level, shift of white
count differential to the left (neutrophilia), increase
ESR (up to 35–40 mm/hr).
 Urine test - presence of bacteria in urine, increase
urinary leucocyte counts.
 X-ray test
 Ultrasound test
Treatment
 The main goal of treatment is to remove the cause
of the phlegmonous process in order to achieve
effective treatment and prevention of residives.
 If the patient's condition is mild and signs of
inflammatory process are present without signs of
infiltrates, then conservative treatment with
antibiotics is sufficient.
 If the patient's condition is severe, however,
immediate operation is usually necessary with
application of drainage system. All of these are
done under general anaesthesia. During operation,
the cavity or place of phlegmonous process are
washed with antiseptic, antibiotic solutions and
proteolyic ferments.
 In post-operative period, patients are treated
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with intravenous antibiotics, haemosorbtion,
vitaminotherapy. Additionally, the use of i/v or
i/m antistaphylococci γ-globulin or anatoxin can
be taken as immunotherapy.
During operation of phlegmon dissection at any
location, it is important:
to avoid spreading of pus during operation;
to take into account the cosmetic value of the
operating site, especially when treating
phlegmmonous process of the face; and
to avoid damaging nerves.
Thanks for your attention