Along with hemorrhoids and fissures of the rectum, the disease is one of the most frequent reasons for visits to the specialist. Treatment paraproctitis engaged proctologist. Available in the human body infection, whether it be the flu or a sore throat, penetrate into the fatty tissue of the rectum through the microscopic lesions of the mucous membrane and cause its inflammation.
What it is?
Abscess - an acute or chronic inflammation adrectal fiber. This is one of the most frequent diseases Proctologic (20-40% of all diseases of the rectum). Paraproctitis frequency stands in 4th place after hemorrhoids, anal fissures and colitis.
Men suffer more than women. This ratio ranges from 1.5: 1 to 4.7: 1. Abscess - a disease of adults: rare description of fistulas of the rectum in children.
The causes of the disease
The primary cause, causes the appearance of disease, is an infection (E. coli, staphylococci, streptococci), falling into the cell space from the rectum. Any wound, injury, domestic and microtrauma, mucosal operation - the entrance gate to such infections.
Staphylococci and streptococci penetrate the cellular space, not only through the cracks in the rectal mucosa. There is an inner path of caries, sinusitis or any other center of indolent (chronic) infection. Since blood and lymph pathogens from the epicenter inflammation transferred into other organs and tissues.
Another way the penetration of pathogens into the cell space is plugging the anal gland duct.
The appearance of the disease is favored poor diet, sedentary lifestyle and the presence of low-intensity inflammatory processes. Additional aspects that increase the risk of disease:
- a weakened immune system;
- diabetes;
- arteriosclerosis;
- anal intercourse;
- cracks in the anus.
In particularly severe manifestations of the disease inflammation is able to cover several areas near the intestines.
Classification
pathology forms:
- depth pathology location - superficial, deep;
- the flow - acute (first formed) and chronic (formed fistula);
- with respect to the anal sphincter fistula - intra-, extra- and transsfinkteralny;
- complexity structure sinus tracts - simple and complex (multiple strokes, streaks and purulent pockets);
- by the presence of fistula output - incomplete (only entrance through the anal crypt) and full (abscess found a way out through the skin in the abdominal area or in the lumen of the rectum);
- Localization septic foci - subcutaneous, submucosal, intrasfinkteralny (located between the fibers of the external and internal sphincter) ishio-rectal (Abscess located in the perineum, outside the anal sphincter), Pelvoux-rectal (high position high threat of total purulent process).
symptoms of abscess
Since abscess - a purulent inflammation, it will be characterized by the classic symptoms for him:
- increased body temperature to the critical exponents;
- pain in the area of education abscess syndrome - patients complain of inability to sit and walk;
- tissue around the anus become red-blue color;
- sick feeling himself at the place of inflammation determines the swelling of tissues.
The acute form characterized paraproctitis and general signs of intoxication - nausea and dizziness, vomiting, and slight tremor of the upper extremities, severe weakness. Be sure there is suppuration.
Chronic abscess has all the symptoms characteristic for acute forms of the disease, but in a less pronounced form. Viewed inflammation chronic nature has one feature - it always leads to the formation of a fistula. Through the opening of the fistula occurs regularly expiry of purulent fluid sukrovichnoy - constant irritation of the perineum leads to severe itching. Such paraproctitis not able to self-cure. With each scale relapse pathological process only increases more destroying the patient's body. Gradually there are severe complications in the form of necrosis, malignant transformation abscess.
Since the symptoms of acute abscess is quite specific, if they are detected it is important to apply as soon as possible to proctologist, in order to avoid life-threatening consequences and to prevent the transition of the disease into a chronic stage.
Diagnostics
For diagnosis, usually collect enough complaints, history of disease and visual inspection. In rare cases, particularly in the deep location of the abscess may be difficulties in differentiating the diagnosis. Then may require imaging studies such as computed tomography or ultrasound rectal probe.
In the presence of fistulae is carried fistulography - staining fistulous for determining its depth, length and direction of travel.
Laboratory Methods determine the presence of inflammation.
Treatment of acute abscess
In acute paraproctitis operation is shown. It needs to be made as early as possible (surgery for acute paraproctitis is classified as urgent). Otherwise, you may develop complications and the transition of acute abscess in chronic.
Operation during paraproctitis runs as follows:
- The surgeon specifies the location of the ulcer using a rectal examination on the rectal speculum.
- Then opened the abscess and cleaned of pus. The surgeon must carefully examine the cavity to open all the pockets, to destroy existing partitions.
- Abscess cavity was washed with antiseptic solution.
- The wound left to drain (graduate, through which flows away pus ichor).
- The rectum special gas discharge tube can be inserted.
- Later dressings are available daily, the patient is prescribed antibiotics.
Pre surgeon and anesthetist inform the patient about the features of the operation and anesthesia, tell us about the possible complications and risks. The patient must sign a written consent for surgery and anesthesia.
Local anesthesia during surgery for acute abscess can not be used, as it often is not able to eliminate the pain completely. Insert the needle may facilitate the spread of pus. It is used general anesthesia: a mask or intravenous.
The three main tasks that must decide the doctor during surgery:
- uncover and clean the abscess;
- excise the affected crypt - since it is the source of purulent infection;
- to cut and clean the abscess course, that connects and crypt abscess.
The deeper the ulcer, the harder and harder operation. When the operation in a timely manner favorable prognosis. If the patient has not turned in time to see a doctor, the acute abscess becomes chronic, complications develop.
Treatment of chronic abscess
If the patient is diagnosed with a chronic abscess, you need to excise the fistula formed. But during an active purulent inflammation paraproktitnogo fistula surgery is contraindicated, so doctors at first reveal abscesses, clean them on the contents and drained - then you are ready to operations.
If the fistula channel has infiltrated area, physicians first performed antibacterial therapy using physical therapy techniques. However, surgery to remove the fistula should be carried out as quickly as possible after a preliminary treatment - relapse with purulent inflammation is inevitable.
Important: old age, severe somatic diseases and closing sinus tract is a contraindication to surgical treatment of a chronic abscess. Doctors must first stabilize the patient and then send it to surgery.
complications
Chronic abscess is characterized by a high risk of complications:
- Spontaneous dissection abscess.
- Necrotic and purulent fusion of the walls of the vagina, urethra.
- Overgrowth of scar tissue and decrease the elasticity of the anal canal walls.
- Malignant degeneration in the presence of a fistula for more than 5 years.
- Yield feces in paraproctium necrotic through the rectum wall, a lightning propagation purulent process.
- Breakthrough abscess in the abdominal space and the development of peritonitis, threatening death.
- Anal sphincter insufficiency due to severe damage of its fibers, leakage of feces.
When the first signs of abscess requires emergency surgical care. The timing of its delivery prognosis depends.
prevention
Prevention abscess is simple:
- avoidance of hypothermia;
- strengthening the immune system;
- observance of personal hygiene rules;
- timely treatment of diseases of the rectum (hemorrhoids, anal fissure, etc.);
- treatment of diseases accompanied by itching and skin irritation around the anus (parasitic infestation, diabetes, colitis);
- normalization of digestion in order to prevent the occurrence of constipation and diarrhea.
