Paraproktit – involvement in inflammatory process of cellulose of a rectum. There is a sharp morbidity in the field of back pass and a crotch, high temperature, a fever, violation of defecation and an urination. Locally - hypostasis and reddening of anal area, formation of infiltrate and an abscess. Complications – development of a chronic paraproktit, fistulas, involvement in inflammatory process of bodies of urinogenital system, sepsis. Treatment is always surgical.
Paraproktit – the disease which is characterized by an inflammation and suppuration of the fabrics surrounding a rectum as a result of penetration of a bacterial infection from a rectum gleam through anal glands of a bottom of morganiyevy crypts in deep layers of pararectal area. Paraproktit divide on sharp (for the first time revealed) and chronic (it is long existing, recuring). Chronic paraproktit is result of insufficient or wrong treatment of a sharp paraproktit.
The causative agent of an infection in case of a paraproktit most often is the mixed flora: staphylococcus and streptococci, colibacillus. In certain cases the specific infection can be noted: klostridiya, actinomycosis, tuberculosis. Specific paraproktit meets not more often than at 1-2% of patients.
Chronic paraproktit usually covers a morganiyevy crypt, space between internal and external sphincters and okolopryamokishechny cellulose. Result it is long the existing chronic paraproktit of such scale there can be pararectal fistulas of a rectum (the pathological channels connecting a rectum to skin or nearby hollow bodies). Detection of pararectal fistula speaks about the sharp paraproktit taking place.
Classification of a sharp paraproktit
Sharp paraproktit depending on localization and prevalence of process is subdivided into hypodermic paraproktit (pararectal abscess), intrasfinkterny, ishiorektalny and pelviorektalny paraproktit. Hypodermic paraproktit it is characterized by purulent fusion of hypodermic cellulose in perianalny area. This type of a paraproktit most easily gives in to treatment and has the most favorable forecast.
At an intrasfinkterny paraproktit the inflammation mentions tissues of an anal sphincter, at an ishiorektalny paraproktit purulent process is localized in a podvzdoshno-pryamokishechny pole. The inflammation at a pelviorektalny paraproktit develops in a small pelvis.
Risk factors of development of a paraproktit
Development of a paraproktit is promoted by decrease in immune properties of an organism, the general exhaustion, chronic diseases of bodies and systems, a sharp or chronic infection of a digestive tract, specific infectious diseases, frustration of a chair (locks or ponosa), proktologichesky pathologies (proktit, hemorrhoids, an anal crack, kriptit, papillit).
Symptoms of a sharp paraproktit
Sharp paraproktit is shown by symptoms, pain, hyperaemia, a hyperthermia and hypostasis of fabrics, a gnoyetecheniye, characteristic of a local purulent inflammation.
Unlike nonspecific aerobic flora, anaerobic microorganisms promote not purulent fusion, but necrotic destruction of fabrics. Prevalence putrefactive anaerobic flora promotes development of a putrefactive paraproktit who is characterized by large-scale defeat, high speed of destruction of fabrics and the expressed intoxication. At a neklostridialny anaerobic paraproktit often muscles and fastsialny structures are involved in pathological purulent process.
Symptoms of a chronic paraproktit
Chronic paraproktit is result of an undertreated sharp paraproktit therefore the symptomatology it most often repeats that a sharp paraproktit, however their expressiveness usually is less. At a chronic paraproktit pararectal fistula which is shown by allocations to the area of a crotch of an ichor or pus often develops. Constant allocations promote irritation of skin of a crotch and developing of an itch.
Well drained (the having free exit for pus) pararectal fistula usually does not disturb the patient pain or discomfort. The painful symptom is characteristic of incomplete internal fistula. At the same time pain amplifies during defecation and abates after it (it is connected with improvement of drainage of fistula at the time of stretching of the anal valve).
Clinical symptoms of pararectal fistula are shown wavy, abating and again becoming aggravated. It is connected with periodic obstruction of a svishchevy gleam, formation of purulent abscess after which opening there comes simplification. Independently fistula does not heal, purulent processes in it continue. If in purulent separated there were blood impurity, it is necessary to make researches regarding a malignancy.
Diagnostics of a sharp paraproktit
For preliminary diagnostics the proctologist has enough data of poll, survey and fizikalny inspection. Characteristic clinical signs: fever, local morbidity, symptoms of a purulent inflammation. In view of extreme morbidity of procedures, a manual research of back pass and methods of tool diagnostics proktologichesky diseases (an anoskopiya, a rektoromanoskopiya) are not made. At blood test signs of a purulent inflammation are noted: with neytrofilezy, increase in SOE.
Sharp paraproktit generally it is necessary to differentiate from the suppurated teratoma of okolopryamokishechny cellulose, tumors of a rectum and the fabrics surrounding it, abscess of a duglasov of space. Need to make additional researches for differentiation of a paraproktit from other diseases usually arises in case of a high arrangement of an abscess (in a small basin or a podvzdoshno-pryamokishechny pole).
Diagnostics of a chronic paraproktit
Chronic paraproktit diagnose, examining a crotch, back pass, making a manual research of the anal channel. At detection of fistula make sounding of its course. As tool diagnostics the rektoromanoskopiya, an anoskopiya, a fistulografiya is applied - if fistula is located highly, there are plentiful allocations and there is a balloting (fluctuation) of the probe in channel. Also the ultrasonografiya is applied.
The created pararectal fistula needs to be differentiated from a cyst of okolopryamokishechny cellulose, osteomyelitis of terminal departments of a backbone, tubercular fistula, the epitelialny coccygeal course and fistulas at patients with a disease Krone. For the differential diagnosis the given the anamnesis, laboratory researches, a X-ray analysis of a small pelvis are significant.
Complications of a sharp paraproktit
The most dangerous complication of a sharp paraproktit is penetration of purulent process into the spaces of a small pelvis filled with cellulose, and also purulent fusion of all layers of an intestinal wall above the anorektalny line. At the same time there is an exit of kalovy masses in pararectal cellulose, striking nearby bodies and threatening with an infection exit to the blood course (development of sepsis).
The anatomic proximity of a pelvic peritoneum does possible spread of an infection with development of peritonitis. The neighbourhood of pelvic cellulose from zabryushinny allows to break to pus in zabryushinny space. Such distribution of purulent process is characteristic of the elderly and weakened faces at the late address to the doctor.
In addition, paraproktit can be complicated by break of abscess in a rectum, a vagina, on crotch skin. Usually after spontaneous opening of an abscess without implementation of measures for drainage the course is formed svishchevy. If fistula was not created, but the center of an infection remained, then over time there is a recurrence – formation of a new abscess.
Complications of a chronic paraproktit
Long existence of the fistula of a rectum especially having complex structure of the channel (sites of infiltration, purulent cavities) promotes considerable deterioration in the general condition of the patient. The chronic course of purulent process leads to cicatricial changes, deformation of area of the anal channel, a rectum.
Deformation results in tonic insufficiency of an anal sphincter, an incomplete smykaniye of anal pass, dribble of intestinal contents. Other frequent complication of a chronic paraproktit is pathological scarring () of walls of the anal channel and decrease in their elasticity that leads to violations of depletion of intestines. For a long time existing fistula (more than 5 years) can .
Treatment of a paraproktit
Paraproktit demands surgical treatment. Right after establishment of the diagnosis of a sharp paraproktit it is necessary to make operation on opening and drainage of the purulent center. As relaxation of muscles and high-quality anesthesia are important factors, full anesthesia of an operational zone is necessary. Operation is performed under peridural or sacral anesthesia, in certain cases now (at damage of an abdominal cavity) give the general anesthesia. Local anesthesia when opening pararectal abscesses is not produced.
During operation find and open a pus congestion, pump out contents then find the crypt which is an infection source and excise it together with the purulent course. After full removal of the center of an infection and high-quality drainage of a cavity of abscess it is possible to count on recovery. The most complex challenge is opening of the abscess which is settling down in a cavity of a small pelvis.
At a chronic paraproktit the created fistula needs to be excised. However operating concerning removal of fistula in the period of an active purulent inflammation is impossible. At first make opening of the available abscesses, make careful drainage, only after that it is possible to delete fistula. In case of the infiltrirovanny areas which are available in the channel, as preoperative preparation appoint the course of anti-inflammatory and antibacterial therapy which is quite often combined with methods of physiotherapeutic influence. It is desirable to carry out surgery for removal of the svishchevy course as soon as possible as the recurrence of an inflammation and suppuration can take place quickly enough.
In certain cases (senile age, the weakened organism, a serious dekompensirovanny illness of bodies and systems) operation becomes impossible. However in such cases it is desirable by conservative methods to make treatment of pathologies, to improve a condition of the patient and then to make operation. In certain cases, when at long remission there is a smykaniye of the svishchevy courses, operation is postponed as accurate definition of the channel which is subject to excision becomes problematic. It is expedient to operate when there is well visualized reference point – the course opened svishchevy.
The forecast at a paraproktita
After timely full surgical treatment of a sharp paraproktit (with excision of the struck crypt and purulent course in a rectum) there occurs recovery. In the absence of treatment or insufficient drainage, not removal of a source of infection, there is a synchronization of a paraproktit and formation of the svishchevy course.
Excision of the fistulas which are settling down in the lower parts of okolokishechny space, as a rule, also conducts to an absolute recovery. More highly located fistulas can be most often removed without complications, but is sometimes long the existing svishchevy courses promote distribution of a slow purulent inflammation to remote anatomic formations of a small pelvis that leads to incomplete removal of an infection and the subsequent recurrence. Extensive long purulent process can provoke cicatricial changes in walls of the anal channel, sphincters, and also adhesive processes in a small basin.