Paraproctitis - Causes, Symptoms and Treatment .MF .
Paraproctitis - is purulent inflammation of adipose tissue located around the rectum and the anal sphincter.Purulent abscess is acute or chronic.Acute abscess is formation of abscesses (cavities bounded with pus) fat.Chronic abscess manifested adrectal (okolopryamokishechnymi) and perianal (around the anus) fistulas occurring frequently after acute abscess.Paraproctitis is the most common disease of the rectum after hemorrhoids.
The following figure shows the location of the abscess in acute paraproctitis:
and - subcutaneous abscess;
b - ishiorektalny or iliac-rectal abscess;
with - pelviorektalny-rectal or pelvic abscess;
d - submucosal abscess;
arrow shows the crypt Morgan.
paraproctitis Pathogens are bacteria.Most often it is E. coli, rarely staphylococci, enterococci and anaerobic bacteria.
infection gets into the fatty tissue of the lumen of the colon as a result of wounds mucosa, anal fissures.The most common gateway are crypt Morgan - a peculiar folds of the ana
predisposing factors for paraproctitis:
• frequent constipation;
• hemorrhoids, anal fissures;
• weakened immunity due to alcoholism, exhaustion after suffering flu, sore throat;
abscess The clinical picture varies considerably depending on the location of the purulent focus.At the beginning of the disease it is marked with a short period of malaise, weakness and headache.Marked rise in temperature above 37.5 ° C fever.
When subcutaneous paraproctitis , when the abscess is located near the anus beneath the skin, the symptoms of the most striking: painful swelling in the anus, with redness of the skin over it.Pains gradually increase, getting an intense pulsing character, making it difficult to sleep, sit, defecation becomes extremely painful softening of the tumor appears.This form of abscess is the most common.
Submucous abscess located under the mucous membrane of the rectum.Symptoms of this type of arrangement similar to subcutaneous abscess, but the pain and skin changes are less pronounced.
When ishiorektalnom abscess festering hotbed located above the muscle that raises the anus.Because of the deep-seated abscess local symptoms are more vague: dull throbbing pain in the pelvis and rectum, worse during bowel movements.Changes in the skin in the form of redness, swelling occur after 5-6 days from the occurrence of pain.The general feeling heavy: the temperature can rise to 38 ° C, expressed intoxication.
most difficult runs pelviorektalny abscess .This is a rare form of acute abscess when purulent center is located above the muscles that form the pelvic floor, from the abdominal cavity it is separated by a thin layer of the peritoneum.At the beginning of the disease is dominated by high fever, chills, pain in the joints.Local symptoms: pain in the pelvis and abdomen.After 10-12 days, the pain intensifies, there is a delay in stool and urine.
In a separate group of isolated necrotizing paraproctitis .This form is characterized by rapid rasprotraneniem abscess infection, accompanied by extensive necrosis of soft tissues and require their excision, after which remain large skin defects requiring skin plasty.
Chronic abscess manifested purulent fistulas.Mouth of sinus tracts are located near the anus or rectum at a distance from him on the buttocks.The pain is usually not expressed.From the mouth of the fistula pus often with an admixture of faeces.During the development of a chronic abscess fistula opening can be closed, pus coming delay the development of abscesses, new defects in tissue, pus and break the expiry of his rectum and out, necrotic tissue, and other changes, largely complicating fistulas.Thus, there are complex systems with fistulous fistulous ramifications, cavitary station and a plurality of openings.
The figure shows how many and varied are the system of sinus tracts in chronic paraproctitis.
Diagnostics If you experience these symptoms should consult a surgeon.The correct diagnosis is of fundamental importance the clinical picture and examination by the surgeon.For a more precise determination of the localization of abscess may need a digital rectal examination, but in most cases it is sharply painful and is performed under general anesthesia in the operating room immediately before surgery.
Upon confirmation of the diagnosis of acute abscess requires hospitalization in a surgical hospital on duty.When a normally must pass a complete blood count, blood glucose, urinalysis.
Treatment of chronic abscess holds surgeon proctologist, because in this case requires a more complex operation, but the initial examination usually performs general surgeon.
abscess Symptoms are similar to the following diseases: fester teratoma (tumor) adrectal tissue, abscess Douglas space, tumors of the rectum.Subcutaneous abscess can be confused with abstsediiruyuschim furuncle and festering atheroma.In any case, these diseases require inspection of the surgeon.
perform ultrasound crotch area may be required in difficulty in diagnosis.Ultrasonography allows you to set the location and size of the ulcer, the character changes in the surrounding tissues.The use of a rectal ultrasound probe aids in topical diagnosis of purulent course and affected the crypt.Fistulography to evaluate the direction of the fistulous with chronic paraproctitis lies in the introduction of contrast medium into the fistula, followed by radiographic examination.X-ray or computed tomography sacrum and coccyx can help in the diagnosis of congenital tumor.
Treatment abscess surgery alone.In acute paraproctitis perform an operation on opening purulent cavity, it is necessary to perform immediately after diagnosis.The operation is performed under general anesthesia, usually under intravenous anesthesia or use cerebrospinal anesthesia where the patient does not feel pain in the lower half of the body, but it remains in mind.The aim of the operation - opening an abscess, pus evacuation and staging drainage.In the future, the wound are open, it heals by itself or impose secondary sutures.
perform operations allows to stop purulent process, but does not eliminate the disease, because the cause of the disease is the intake of pus from the crypt rectal fistula on the go.Therefore, an attack of acute abscess may recur or may develop chronic abscess with fistulous passages in the skin.So after acute abscess should consult with a surgeon-proctologist on the implementation of radical surgery.
Chronic paraproctitis perform more complex operations, which allows for reception of disease remission.The aim of the operation - to excise the fistula canal with defective tissue to interrupt the communication with the rectum and create favorable conditions for wound healing.You must know that fistulous passages may be located outwards from the sphincter of the rectum.When excision of fistula canal sphincter injury can lead to anal incontinence - leaking stool and gas.Therefore, at the location of the fistula outwards from the anal sphincter is used as ligature method, which is to hold the thread through the fistula, and tying it.Gradually, she cuts through the sphincter, and then tie it tighter.Due to the slow eruption through the anal pulp, sphincter, rectum time to recover, to avoid these complications.
Postoperatively conducted antibacterial therapy (cefotaxime, gentamicin, amikacin) and perform daily dressings with antiseptic ointments (Levomekol).
To achieve stable effect in addition to radical surgery is necessary to adhere to certain rules.
• Fight against constipation.The need to achieve a regular soft stools.
• The diet should include fiber-rich plant foods (vegetables and fresh fruit, especially beets, cabbage) and dairy products (kefir, yogurt, cottage cheese).Avoid products made of pastry.
• In diabetes need to maintain a normal blood sugar level, otherwise not escape purulent diseases.
• Maintain a normal body weight.
• Observance of rules of personal hygiene - regular washing away after stool.
• Treatment of chronic hemorrhoids and anal fissure.
Be aware that delay in the appeal to the surgeon in case of symptoms of the disease can lead to tragic consequences, among which are the following.
• purulent fusion of the wall of the rectum with the spread of intestinal contents in adrectal fiber.Wide access adrectal fiber for bowel contents can cause even more serious consequences listed below.
• Education purulent fistulas between the rectum and the vagina.
• purulent fusion of the urethra, the passage of purulent process in the scrotum, followed by gangrene.
• pus breakthrough in the free abdominal cavity and retroperitoneal fat with peritonitis and retroperitoneal cellulitis that lead to sepsis (blood poisoning) and death.
• Necrosis of the skin in the area of dissemination of the ulcer.
Thus, the only way of preventing complications is early to seek medical help from a surgeon.
the words of William Shakespeare: "The excessive slowness leads to a sad end."So take care of your health.It is better to overestimate the severity of your symptoms, rather than later, seek medical attention.
Surgeon Thews DS