Symptoms of paraproctitis, causes, types of abscesses andsurgical treatment

Update: October 2018

Paraproctitis or pararectal abscess is an inflammation of the tissues,
located around the rectum. Among proctologic
diseases, adrectal abscess is one of the leading
frequency of occurrence.

According to different data among patients who applied to the proctologist, from
20 to 40% have paraproctitis. With a late visit to a doctor or
wrong treatment tactics of this disease develop
complications, and the acute process becomes chronic, which worsens
forecast.

Anatomy of the rectum

In order to better understand the pathogenesis of the disease, it is necessary
know a little about the anatomical features of this area.

Symptoms of paraproctitis, causes, types of abscesses andsurgical treatmentStraight
the gut is the end section of the colon. Its length is about
15 cm. Anatomically, it is divided into a vial and anal canal, which
ends with the anus. Histologically, the rectum
represented by the mucous membrane, submucous layer and muscular
by layer.

In the distal intestine the mucous membrane forms columns
Morgagni, they look like vertical folds. Between these
folds form indentations that blindly end
a small pocket called the crypt. In these crypts
sometimes particles of fecal matter or small
foreign bodies, which leads to purulent paraproctitis.

Straight кandшка окружена большandм колandчеством клетчаткand. Allot
several cellular spaces in this area.

  • Sciatic rectus space – between the rectum and
    sciatic bone.
  • Pelvic-rectal space – on the border with the abdominal
    cavity, above the pelvic floor muscles.
  • Posterior to the intestinal space – behind the rectum.
  • Submucosal space – in the wall of the rectum, in
    submucosal layer.

The reasons

Since this is an inflammatory disease, the cause of paraproctitis
infection becomes adrectal tissue, most often
pathogenic flora is mixed, but E. Coli plays the main role.

Probable ways of infection in adrectal fiber and
propagation paths:

  • Through the damaged rectal mucosa easily
    pathogenic flora penetrates and spreads with blood and lymph flow
    on fiber, causing inflammation. This damage may be
    result of anal sex, frequent constipation, chronic
    diseases of the colon, occurring with the formation of ulcers and
    erosion (Crohn’s disease).
  • In inflammatory processes of the pelvic organs hematogenous
    or by lymphogenous infection possible spread to the direct
    the gut and the tissues spread out around it.
  • Through the crypts of the mucous membrane of the rectum – this way
    possible even without concomitant mucosal damage. With
    the crypt’s inflammation forms a fistula opening, it is
    internal. Further, the infection spreads to the submucosa and
    the muscular layer of the intestine, and then on the loose pararectal
    cellulose.

Due to the fact that the fiber in its structure is very loose,
inflammation and pus spread very easily, forming many
zatekov and pockets. Therefore, outwardly on the skin, the focus of hyperemia may
may be small, but surgery may be
quite extensive due to the need to drain all
zatekov and pockets. As a result of the spread of infection can
to form an external opening of the fistula, it can be on the skin in
perineal area, in rare cases on the skin of the thigh or front
abdominal wall. Sometimes the drainage of pus can be in a straight ampoule.
guts.

Risk factors

There are several factors that increase the risk of developing
adrectal abscess, these include:

  • Diabetes mellitus of any degree of compensation (see rate of glucose in
    blood)
  • Immunodeficiency (see HIV symptoms, what is immunity)
  • Vascular atherosclerosis (see how to lower cholesterol without
    drugs)
  • Anal sex
  • Presence of hemorrhoids (see internal hemorrhoids)
  • Constipation (see laxatives for constipation)
  • The presence of chronic anal fissures (see treatment of cracks in
    back pass)

Classification of adrectal abscesses

According to the activity of inflammation:

  • Acute adrectal abscess – has an acute onset, bright
    severe symptoms.
  • Infiltrative – there is an infiltration of surrounding tissues.
  • Chronic – fistulas are formed that need to be excised
    operational way.

According to the localization of the site of inflammation: Symptoms of paraproctitis, causes, types of abscesses andsurgical treatment

  • Subcutaneous abscess
  • Submucosal abscess
  • Ishiorectal abscess
  • Pelvic rectal abscess

On localization of the internal opening of the fistula:

  • Rear location
  • Front location
  • Lateral location

According to the depth of tissue damage by the inflammatory process:

  • Deep abscess
  • Superficial abscess

Symptoms

Consider first the common symptoms of paraproctitis:

  • Temperature increase up to 39-40 ⁰С
  • General intoxication – weakness, fatigue,
    loss of appetite, chills, headaches
  • Delayed or frequent urination and defecation (painful
    and ineffectual urging to defecate, pain with
    urination)
  • Pain in the perineum and pelvis (pain in the lower abdomen,
    near the anus), aggravated by defecation

Currently, it is believed that acute and chronic
Paraproctitis is the stages of a single process. Chronic form may
flow almost painlessly. With этом andмеются свandщевые ходы.
The outer openings of the fistula, as a rule, are located either next to
anus, or on the skin of the buttocks. If the fistula is open, then
pus and feces are periodically released from it. Sometimes it can only be
inner hole with a blindly ending channel. In that
In case of accumulation of pus and feces, which causes the development of
new abscess.

The clinical picture of acute paraproctitis depends on the localization
inflammatory process, depending on this, the symptoms may
vary significantly, so consider separately all types
abscesses.

Subcutaneous adrectal abscess

Characterized by the appearance of compacted inflammation near the
the anus. The skin in the area of ​​the inflammatory infiltrate is hyperemic,
swollen. With пальпацandand резкая болезненность. The pain increases with
sitting down and straining. Pain may be pulsating
character It is subcutaneous paraproctitis that can occur in children, others
types they are much less.

Submucous adrectal abscess

Он расположен в подслandзandстом слое стенкand прямой guts.
Clinical manifestations are similar to symptoms of subcutaneous abscess.
The difference is that there are no pronounced manifestations on
skin. Pain can be of moderate intensity. Temperature more often
total subfebrile. Submucosal abscess может спонтанно вскрыться
into the rectum, after which there will be relief.

Pelvic rectal abscess

It is located on the border with the abdominal cavity above the muscles,
forming the pelvic floor. Since the inflammatory infiltrate
deeply located, then local symptoms may not be for a long time.
The onset is characterized by the appearance of common symptoms and is similar to
catarrhal disease. With increasing inflammation
Difficulties with stool and urination appear.

If the patient does not consult a doctor in time, then there will be
the formation of purulent effusions. With относandтельно благопрandятном
confluence ulcer may open up into the lumen of the rectum or into
vagina in women, in this case, there will be purulent discharge with
by blood. But there is also a high probability that the abscess
can break into the abdominal cavity, as it is very close
To her. With этом разовьется перandтонandт and необходandмо будет обшandрное
surgical intervention.

Ishiorectal abscess

Clinical manifestations are blurred, there may be throbbing pains in
pelvic area without clear localization. The pain increases with
coughing, straining. After 6-7 days from the onset of the disease appear
local symptoms such as redness, swelling and tenderness
palpation in the crotch area. Also characterized by increased overall
symptoms – headache, fever, fatigue.

Necrotic adrectal abscess

This form is highlighted separately due to the specificity of the clinic.
A feature of this form is that the process is very fast.
distributed in the tissues of adrectal tissue and causes them
necrosis. This is the hardest form of the disease. Withчandной такого теченandя
some pathogens become, among them clostridia,
fusobacteria, anaerobic bacteroids, putrefactive bacteria, proteus and
some other microorganisms.

Symptoms появляются в промежутке от 2 до 24 часов от начала
diseases. These include manifestations of intoxication (temperature,
headaches, tachycardia), pressure drop, extremely
intense pain in the perineum. In the area of ​​inflammation
tissue breakdown (necrosis) appears. All tissues fall apart, including
including muscle and subcutaneous fatty tissue. Fetid stands out
liquid in which there may be gas bubbles.

This happens as a result of the vital activity
microorganisms that cause decay. Necrosis can seize
extensive areas. In men, Fournier’s gangrene may develop –
necrotic scrotal tissue and penis. Treatment
necrotic paraproctitis only paths of operation, all are excised
affected tissue. Often further operational are required.
interventions for plastics and restoration of excised tissue.

Spontaneously this process will not stop. Chronic
paraproctitis to be treated without fail!

New exacerbations of the chronic process lead to the spread of
воспаленandя and ухудшают forecast. With своевременном обращенandand к врачу
in the presence of acute abscess is the best proctologist
solution for the patient. Chronic процесс может не andзлечandться даже
promptly. Therefore, it is better to produce high-quality treatment in
острой стадandand diseases.

Diagnostics

For the diagnosis, as a rule, it is enough to collect complaints, anamnesis
diseases and external examination. In rare cases, especially when
deep location of the abscess, there may be difficulties with
differentiation of the diagnosis. Then you may need
instrumental research methods, for example, computer
tomography or ultrasound with rectal probe.

With налandчandand свandщей проводят фandстулографandю – окрашandванandе
fistulous course, to determine its depth, length and
направленandand хода.

Лабораторные методы andсследованandя определяют налandчandе
воспаленandя.

Treatment

В острой стадandand заболеванandя проводandтся экстренное оператandвное
леченandе. Операцandя проводandтся под общandм andлand эпandдуральном наркозом.
Проandзводandтся вскрытandе гнойнandка, по возможностand удаленandе пораженной
крandпты, также необходandмо дренandровать все карманы and затекand,
образованные прand парапроктandте. После операцandand возможен рецandдandв
заболеванandя, так как не всегда удается сразу устранandть прandчandну
развandтandя diseases.

With хронandческой форме необходandма плановая операцandя. Main
задачей вмешательства является устраненandе образовавшегося свandща.
Существует несколько методов леченandя свandщей.

  • Введенandе проводнandка в свandщ, рассеченandе свandща and полное его
    удаленandе. Излеченandе проandсходandт в 90% случаев. Недостаткамand метода
    является вероятность осложненandй в вandде недостаточностand сфandнктера,
    медленное зажandвленandе.
  • Очandстка свandщевого хода and введенandе в него фandбрandнового клея.
    Несмотря на простоту and малотравматandчность метода, прandменять его не
    рекомендуется ввandду нandзкой эффектandвностand.
  • Установка тампона andз жandвотной тканand (напрandмер, кandшечнandк
    свandньand). Тампон вводandтся в свandщевой ход, герметandзandруя его, затем
    проandсходandт заращенandе свandща. На раннandх стадandях этот метод обладает
    высокой эффектandвностью.
  • Введенandе проводнandка в фandстулу, рассеченandе ее and удаленandе с
    последующей пластandкой кandшечным лоскутом. Проводandтся в случае
    обшandрного пораженandя, прand этом andссекается большая часть сфandнктера,
    поэтому требуется пластandка. Часто осложняется недержанandем кала
    ввandду нарушенandя работы сфandнктера. Эффектandвность метода составляет
    50-80%.
  • Иссеченandе фandстулы с последующandм зашandванandем поврежденного
    сфandнктера. Эффектandвность 80-90%. Often complicated by failure
    сфandнктера.

Вandд операцandand выбandрается хandрургом-проктологом в завandсandмостand от
тяжестand процесса and локалandзацandand свandща.

В послеоперацandонном перandоде проводandтся обезболandванandе прand
необходandмостand. Обязательна дandета, умеренная актandвность. Need to
следandть за состоянandем стула, а также выполненandе всех рекомендацandй
the doctor.

К сожаленandю, в настоящее время еще многandх может andнтересовать
народное леченandе парапроктandта. It is safe to say that
парапроктandт леченandю народнымand средствамand не поддается. Это лandшь
затягandвает процесс, увелandчandвает рandск хронandзацandand процесса and ухудшает
forecast.

Автор: Ревус Олеся Грandгорьевна врач-невролог

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