Paraproctitis – what are these, types, causes, symptoms,treatment of acute and chronic paraproctitis in adults

Paraproctitis (paraproctitis; from the Greek para – about, protostos
– the rectum; латинского itis – воспалительный процесс)  –
it is an acute or chronic inflammation of the fatty tissue of the pelvis, which
surrounds the rectum. Also in the medical literature can
meet the second name of this disease – adrectal
abscess.

Among proctological problems, it occupies a leading position
second only to hemorrhoids and colitis. Statistics states that
paraproctitis in men occurs more often than in women. Most
people of middle age are subject to the disease, but this disease
amazes even babies.

What is this disease, what are the causes and
symptoms in different forms, and what is prescribed as a treatment
with paraproctitis, consider further in the article.

Paraproctitis: what is it?

Paraproctitis

Paraproctitis is an inflammatory process that develops in
the tissues surrounding the rectum. The onset of the first symptoms
this pathological process is always associated with the penetration
infections through the anal glands from the lumen of the rectum into the deep
layers of the adrectal region.

The disease is characterized by the occurrence of severe pain
in the area of ​​the perineum and anus, temperature increase,
появлением проблем при мочеиспускании и defecation. By local
manifestations are redness and swelling of the anal area,
the occurrence of infiltration (compaction) and further ulcer.

Spontaneous opening of the abscess gives only temporary
relief, and repeated suppuration is fraught with fistula formation,
leaving either the rectum or through the skin of the anal
zone.

  • ICD 10 code: K61 Abscess of the anus and straight
    guts.

The reasons

The cause of paraproctitis is infection (E. coli,
staphylococci, streptococci) falling into the cellular space of
прямой guts. Any wounds, domestic injuries and micro injuries, surgery
on the mucous membrane – the entrance gate for such infections.

Staphylococci and Streptococci invade cellular space
не только через трещины на слизистой прямой guts. Exists
internal path: caries, sinusitis, or any other focus
sluggish (chronic) infection. With blood and lymph flow
pathogens from the epicenter of inflammation are transferred to other organs and
tissue.

Pathogens can affect any of the tissue spaces,
surrounding intestines:

  • тазово-прямокишечную region;
  • ileo-rectal cellulose;
  • posterior rectal zone;
  • submucosal layer of the rectum;
  • subcutaneous fat layer.

In severe cases, inflammation may cover several
zones.

Factors predisposing to the development of paraproctitis:

  • ослабление иммунитета;
  • exhaustion, prolonged fasting;
  • alcoholism;
  • severe, frequent infections;
  • chronic infections;
  • defeat of small vessels in diabetes mellitus;
  • atherosclerosis;
  • нарушение функций кишечника: поносы, запоры;
  • hemorrhoids;
  • anal fissures;
  • chronic inflammatory process in the pelvic organs:
    prostatitis (inflammation of the prostate gland);
  • cystitis (inflammation of the bladder);
  • urethritis (inflammation of the urethra),
    salpingo-oophoritis (inflammation of the uterus);
  • nonspecific ulcerative colitis;
  • Crohn’s disease.

Kinds

Depending on the infection penetration, the following types are distinguished:

  1. Hematogenous – bacteria penetrate through blood flow either from
    other parts of the rectum in which inflammatory
    process, or from other organs of the body (for example, with caries,
    tonsillitis).
  2. Contact – the spread of infection from the inflamed glands of the digestive tract,
    which break through and give way to bacteria.

Acute Paraproctitis

Paraproctitis, which appeared for the first time and is considered acute
characterized by the formation of suppuration in adipose tissue.
Purulent contents can find a way out, forming a pathological
the channel between the abscess and the adjacent hollow organs or surface
skin (fistula).

It should be noted that the diagnosis of acute paraproctitis itself is
direct indication of the need for surgery.
The acute form of the disease is characterized by its own acute
the beginning, as well as the severity of clinical manifestations.
The intensity of the latter is determined in particular by the location
inflammatory focus, its size, features
the causative agent that provoked it and the overall resistance
organism.

Kinds острого парапроктита в зависимости от расположения
ulcers:

  • подкожный – под кожей в области заднего прохода;
  • подслизистый – в непосредственной близости к прямой кишке,
    under the mucous membrane;
  • ишиоректальный – возле седалищной кости;
  • пельвиоректальный (тазово-прямокишечный) – в полости
    small pelvis;
  • ретроректальный – позади прямой guts.

The figure shows the following types of paraproctitis:

  • (A) – subcutaneous;
  • (B) – ishiorectal;
  • (B) – interphincter;
  • (D) – pelviorectal.

Chronic paraproctitis

Chronic paraproctitis обычно охватывает морганиевую крипту,
the space between the inner and outer sphincters and
perineal tissue. The result is long existing
chronic paraproctitis of this magnitude may be pararectal
rectal fistula (pathological channels connecting the rectum
with skin or nearby hollow organs). Revealing
adrectal fistula says acute
paraproctitis.

The chronic form of paraproctitis is divided:
By fistula anatomy
  • Full;
  • Incomplete;
  • Outer;
  • Interior.
According to the location of the fistula
  • Front;
  • Side;
  • Rear.
Fistulous fibers
  • Intrasphincteritis (inflammation of muscles and sphincter tissues)
  • Extrasphincal;
  • Transsfincter.
By severity
  • Plain.
  • Complicated.

Symptoms of paraproctitis in adults

фото парапроктита

Clinical manifestations of acute and chronic paraproctitis
differ very much, so it is very important to know their initial
symptoms, in a timely manner to consult a specialist.

Common symptoms:

  • temperature rise,
  • weakness,
  • muscle pain, lack of appetite.

Specific signs of paraproctitis:

  • sharp pains of a throbbing / jerking character in the area of ​​a straight line
    intestines that spread when
  • дефекации на всю region small pelvis;
  • painful urination;
  • upset stool and painful urge to empty
    intestines;
  • with a superficial arrangement of a purulent focus – swelling and
    reddening of the skin with the possible opening and expiration of pus.

Symptoms of acute paraproctitis

The development of the disease is accompanied by typical symptoms.
inflammatory process:

  • temperature that can reach 39 degrees;
  • signs of intoxication of the body – weakness, chills,
    headaches, lack of appetite;
  • impaired urination and defecation (pain,
    delay);
  • pain in the area of ​​inflammation (lower abdomen, small pelvis).

Some patients may have a sudden spontaneous
improvement of state of health, pains suddenly decrease, body temperature
normalized. In this case, from the rectum, and in women, sometimes
vagina, there are copious purulent bloody discharge. Such
the picture is typical for the breakthrough of the abscess as a result of melting
intestinal walls (or vagina in women).

Symptoms of the chronic form

Chronic paraproctitis имеет все симптомы, присущие для острой
forms of the disease, but in a less pronounced form.

This type of malady is the result of a mismatched
treatment or if the patient later turned to a specialist. Main
Distinctive features are:

  • the appearance of a fistula on the skin of the buttocks and in the anus;
  • сильная боль при defecation;
  • excretion of feces and pus residues from the fistula;
  • the appearance of itching and irritation in the place of an abscess breakthrough.

If the fistula with chronic paraproctitis has excellent drainage
(there is an absolutely free exit for purulent contents), then
such a manifestation of the disease practically does not bother the patient.
Pain syndrome is noted only in case of incomplete internal fistula,
moreover, the pain becomes more intense during the act of defecation,
and immediately after a bowel movement the patient’s condition comes to
the norm.

In general, the symptoms will depend on the site of localization.
paraproctitis. In the table below, we take a closer look at each
from species.

Paraproctitis Symptoms
Subcutaneous Для подкожного парапроктита характерны следующие симптомы:

  • hyperemia of the skin around the anus;
  • swelling of the tissues of the anus;
  • consolidation under the skin of the anorectal zone, which severely hurt
    palpation.
Rectoctal
  • violation of urination;
  • нарушение акта defecation;
  • purulent discharge with admixture of blood from the rectal canal or
    even the vagina.
Ishiorectal The specific signs of ishiorectal
парапроктита являются:

  • hyperemia of the skin over the purulent focus;
  • tissue swelling in the affected area;
  • asymmetry of the buttocks.
Submucosal Submucosal парапроктит характеризуется такими же симптомами,
as well as subcutaneous, but only not in pronounced skin
manifestations.
Pelviorectal
  • Chills and high fever.
  • Pain in the pelvis and lower abdomen.
  • Delayed feces and urine.
  • Усиление боли к концу второй of the week.

The most dangerous for the patient is necrotic paraproctitis.
For this kind of characteristic instant intoxication, strong
pain covering the entire crotch. In this case, there is:

  • low pressure,
  • increase in heart rate and cyanosis of the skin
    covers.
  • Soft tissue is dying off.

The process is not accompanied by redness and the appearance of pus, instead of
it is marked necrosis and strong gas – rotting with
the release of “swamp” gas.

Necrotic paraproctitis develops due to lesion.
putrefactive microbes, clostridia, fusobacteria, anaerobic
microorganisms.

Complications

Among the most frequent complications that can cause acute
paraproctitis, distinguish the following:

  • The melting of the walls of the rectum or vagina pus;
  • Spontaneity of opening on the skin of the abscess;
  • Возможность перехода очага воспаления в region тазовой
    fiber;
  • Melting pus intestinal wall over the anorectal zone with
    output in adrectal fiber intestinal contents with
    subsequent spread of the infection along with
    process;
  • Opening into the peritoneal cavity of the abscess during the subsequent
    развитии перитонита, а также распространение гноя в region
    retroperitoneal space;
  • The melting of the urethra pus;
  • The spread of purulent inflammation to other fiber
    spaces.

Among other things, paraproctitis may be complicated by an abscess breakthrough.
in the rectum, vagina, perineal skin. Usually after
spontaneous opening of the abscess without the implementation of drainage measures
formed fistulous course.

If a fistula has not formed, but the focus of infection has survived, then with
time, a relapse occurs – the formation of a new abscess.

Diagnostics

Diagnostics парапроктита включает следующие методы:

  • digital examination of the rectum. With it you can
    determine the place of pain and the location of the abscess;
  • sigmoidoscopy. With its help, assess the condition of the mucous
    colorectal membrane and localization of infiltration;
  • clinical blood test. Will show availability
    inflammatory process in the body. Observed high
    leukocyte counts, left shift formula and ESR acceleration
    (erythrocyte sedimentation rate) up to 50 mm / h;
  • puncture of the purulent cavity with the introduction of the dye. Hold
    staining of the fistula with 1% solution of methylene blue.
  • ultrasound, ultrasonography and radiograph
    allow you to determine the placement of the process if other methods
    not enough.

How to treat paraproctitis?

Modern medicine in the treatment of paraproctitis does not shine
diversity, so the best option is
surgical intervention. Assigned to the operation
standard tests:

  • general blood analysis;
  • general urine analysis;
  • examination by an anesthesiologist;
  • electrocardiography.

General anesthesia is applied, the solution is injected intravenously or through
special mask.

The course of the operation:

  • The surgeon specifies the location of the abscess with the help of direct examination
    guts on rectal speculum.
  • Then open the abscess and cleanse the pus. The surgeon should
    carefully examine the cavity, open all the pockets, destroy
    available partitions.
  • The cavity of the abscess is washed with an antiseptic solution.
  • Drainage is left in the wound (a graduate through whom
    pus, malt).
  • A special tube can be inserted into the rectum.
    exhaust gases.
  • In the future, daily dressings are performed, the patient is prescribed
    antibiotics.

After timely complete surgical treatment of acute
paraproctitis (with excision of the affected crypt and purulent course in
rectum) recovery occurs. With no treatment or
inadequate drainage, removal of the source of infection,
chronic paraproctitis occurs and fistula formation
move.

Treatment of chronic paraproctitis

Chronic paraproctitis, like acute, requires prompt
interventions, only in this case the operation is carried out in
planned order and consists in the radical removal of the affected
tissue and fistula. Also surgical treatment complements
conservative therapy that increases the body’s resistance,
accelerates the healing of postoperative wounds, affects the cause and
pathogenesis of paraproctitis.

The reasons for the transition of the disease to fistula form
competent therapy, late referral to a specialist. After
in place of the abscess, a fistula is formed and the contents come out of it,
there comes relief of the patient’s condition. Sometimes the hole is overgrown
alone, but often the fistula remains a focus of inflammation.
Inside get gases and fecal masses, the formation of pus time from
time resumes.

Chronic paraproctitis is treated in a complex, using
antibiotics and physiotherapy. Excision of the fistula produce
surgically.

In the postoperative period, all patients are prescribed therapy.
broad-spectrum antibiotics, detoxification and
restorative therapy, surgical treatment
postoperative wound. Hygiene is shown in this area.
and after discharge from the surgical department of the hospital: washing
warm water with soap 2 times a day and after each act
defecation.

Diet

Especially diets at paraproctitis no. But, for quick
recovery must comply with the diet, which consists
of the following recommendations:

  1. Try to eat food according to the regimen, at least 4-5 times a day,
    after about the same time.
  2. It is necessary at least once a day to take hot food (in
    lunch): soup, broth.
  3. Dinner is better to make light, limit meat products in the evening,
    large amount of carbohydrates.
  4. It is better that all products are low-fat: lean meat,
    chicken breast, turkey, lean fish.
  5. Cooking is better for a couple, as well as boil or bake, but
    limit the use of food fried on a vegetable or creamy
    oil and other fats.
  6. Soups and broths should be weak, secondary, and better
    cook soups on vegetable broths. If you want to make meat or
    fish soup, these products are boiled separately and added to
    ready meal
  7. Drink enough water: at least 1.5 liters per day.

What can you eat with paraproctitis?

  • sauerkraut;
  • carrots in any form;
  • tomatoes, cucumbers, radishes;
  • onions and green onions, spinach;
  • boiled beets;
  • fruits of trees and shrubs;
  • dairy products;
  • low fat steamed meat and fish dishes;
  • black bread;
  • light soups;
  • cereals (except rice);
  • fruit and berry and herbal decoctions;
  • infusions of prunes, lingonberries and rosehip.

Prohibited Products:

  • rice and semolina;
  • strong tea, coffee, cocoa;
  • chocolate;
  • flour products, including and macaroni;
  • cereals;
  • spicy, smoked, sour, fatty;
  • white flour bread;
  • fatty foods;
  • fast food;
  • alcohol.

Folk remedies

Before using any folk remedy, be sure to
consult with your doctor, because can be
contraindications.

  1. Candles from the interior fat and propolis, in a ratio of 10: 1,
    used in postoperative therapy or in chronic
    ailment. Use the tool twice a day for
    of the week.
  2. Collection of plantain leaf, Althea root and yarrow
    brew in the evening. In the morning, decant and drink 4 times a day, 150 ml per
    half an hour before meals. This tea is equally good for treatment.
    paraproctitis, and fistula.
  3. Baths with herbal broth and infusions. For this you
    you will need to collect from the shepherd’s bag, St. John’s wort, Badan, calamus,
    yarrow, oak bark and other plants, with a pronounced
    anti-inflammatory and astringent effect.
  4. Dissolve 10 tablets of mummy in 200 ml of warm water, strain and
    Pour the solution into the basin with 5 liters of water. Курс – 2 of the week. Mumie
    has anti-inflammatory and immunomodulatory effects
    properties.
  5. Take 3 tbsp. spoon Hypericum and fall asleep in 300-350 ml of boiling water.
    Keep on fire for 15 minutes, then strain and immediately lay out
    Hot steamed St. John’s wort on plastic wrap. Sit down on her
    and sit until the grass has cooled. Then undermine the rest
    decoction.

Prevention

The main objective after recovery is to prevent relapse.
paraproctitis. Prevention заключается в следующих мерах:

  • elimination of constipation;
  • a diet that provides the establishment of a regular lung
    stools;
  • maintaining optimal weight;
  • избавление от геморроя и анальных трещин;
  • thorough hygiene, rinsing with cool water after each
    defecation;
  • the destruction of chronic foci of infection in the body;
  • treatment of major diseases (diabetes, atherosclerosis,
    diseases of the gastrointestinal tract, etc.).

Paraproctitis, like any other disease is treatable and
than before you pay attention to unpleasant symptoms and
refer to the proctologist, the higher the chance to prevent development
complications.

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