Paraproctitis called disease where inflammation is formed with the formation of purulent bags (abscess) in the tissues surrounding the rectum.
Abscess occurs as a result of penetration of microbial infection of the rectum into the deeply lying tissue okolorektalnoy fiber.
Causes
The main pathogens paraproctitis and abscess formation are:
- staphylococcia,
- streptococcal infection,
- infection caused by the presence of E. coli,
- mixed flora.
Sometimes it can be identified paraproctitis specific etiology - tuberculosis, syphilis, clostridium, gonococcal or actinomycotic.
For the development of abscess requires a special risk factors dramatically increases the risk of abscesses:
- lowered immunity,
- depletion of the body, vitamin deficiency,
- chronic diseases of the digestive,
- acute infections of the digestive tube,
- constipation,
- problems with the rectum in the form of anal fissures, hemorrhoids, Papillita.
Kinds
Paraproctitis are of two types - acute and chronic.
Acute paraproctitis detected primarily characterized turbulent manifestations, and, based on location, can be:
- subcutaneously, or it is also called adrectal abscess. This purulent fusion of the subcutaneous tissue in the anus area. This is the simplest and easy to view abscess therapy.
- intrasfinkternym (inside sphincter), inflammation and tissue passes to the anal sphincter muscles
- pelviorektalnym inside the pelvic cavity.
- ishiorektalnym when the inflammation extends to the iliac fossa proctal.
In chronic inflammation paraproctitis long, as a result of undertreated acute process, it can spread to morganievu crypt, moving to perienteric fiber.
As a result of a chronic process, there rectal fistulas, nonhealing channels which can connect the intestine to the skin or other organs.
symptoms of abscess
Paraproctitis manifestations are highly dependent on the location of the abscess and its size. Initially manifested malaise, headaches, weakness, chills with a low temperature. Subsequently clinic depends on the type of abscess.
Subcutaneous form gives the most striking symptoms:
- appearance of painful swelling in the area of the anus,
- redness of the skin over the surface of the protrusion,
- sharp pains growing nature, pulsating, or burning, disturbed sleep and normal life,
- painful bowel movements and restraining the urge to a chair,
- softening and fluid feeling of swelling.
For all other forms of the symptoms are similar, but the feeling is not so pronounced and well defined localization.
- Submucosal abscess gives a similar clinic, with less severe pain and minor changes in the skin.
- Ishiorektalnye and pelviorektalnye paraproctitis give pain in the pelvic their increased during defecation, fever and toxemia symptoms, changes in blood purulent character.
- Changes in the skin can be only in the late period of the formation of a breakthrough of pus and fistula.
The chronic form of abscess manifested fistula formation and the expiration of pus. The holes can be opened fistulas around the anus or close to the buttocks, the pain is there, pus stool with impurities and a pungent odor. Fistulas can grow over and over again to break out, exhausting the patient and disrupting the quality of life dramatically.
Diagnostics
diagnostic base - these are typical complaints of pain in the rectum and anus. When the diagnosis requires examination proctologist and surgeon, digital rectal examination, sometimes carried out under general anesthesia in the operating room because of the pain.
Of laboratory methods is necessary blood and urine, blood glucoseAnd in case of doubt - ultrasound examination of the perianal region, including using a rectal probe. In the presence of sinus tracts fistulography shown, the introduction of contrast medium into the fistula with the performance of a series of x-rays.
paraproctitis treatment
A method of treating only surgical paraproctitis - an occasion opening abscess with pus and removing by washing the cavity with solutions of antibiotics, antiseptics, drainage of an abscess.
The operation is performed under intravenous anesthesia or epidural anesthesia. Subsequently open wound is conducted by or with superposition of secondary seams.
Following subsiding inflammation consult proktologa to prepare for surgery to remove the radical causes abscess. In chronic paraproctitis carry out complex operations on excision of fistula and restore anatomical integrity of the pelvic organs.
- After surgery, are treated with antibiotics, and topical treatment - ligation with ointments (gentamicin, levomekol).
- Use sorbents (Applique sorption), hydrophilic ointment base (e.g., Levosin), when a healing - fatty or gelatinous ointments.
- Effectively the local ozonation, laser and ultraviolet irradiation surface wounds, ultrasonic cavitation.
- On the third day after surgery the day and at night the patient is prescribed for 20-30 grams of castor oil.
- Diet - easily digestible besshlakovaya. After surgery, prescribe a diet rich in vegetable fiber, with plenty of fluids.
patients after the operation mode generally active, but depends on the method of operation produced.
Complications and prognosis
When tightening with abscess treatment may cause serious complications - purulent fusion of fiber with the formation of a common inflammation of the pelvic organs. Fistulas may form between the intestine and the vagina in women, and prostate, scrotum in men. It may also be sepsis and death due to breakthrough of pus into the peritoneal cavity.
Paraproctitis has forecast depending on the severity and complications. Treatment of his long, difficult, may be relapses. At full recovery may take several months.
