Rectal fistula

As it is acute paraproctitis, when the abscess is located behind the rectum (retroactively paraproctitis).
It should be noted that for all types of acute paraproctitis comes in a significant change in the pattern of blood. Appear leukocytosis, left shift formula, increased erythrocyte sedimentation rate. When the pelvic-pryamokishechnye the paraproctitis these changes are expressed most clearly. Leukocytosis sometimes reaches 20 thousand and more. ESR is increased up to 50 mm/h, appears toxic granularity.
Surgical treatment lies in the opening of abscess outside of the anus on the affected side. It should be noted that when the pelvic-pryamokishechnye the paraproctitis not always easy to find an abscess. The operation may not be technically complex, requiring special skills, and it is expedient to carry out under General anesthesia.
Opening isaretleri and pelvic-pryamokishechnye of paraproctitis is only in stationary conditions.
As already mentioned, paraproctitis occurs as a result of the trauma of the mucous membrane of the anus, resulting in the infection of the rectum penetrates into the pararectal cellular tissue.
The emergence of paraproctitis contribute persistent constipation, accompanied by passing through the anal canal solid "sheep" Kala, easily damage the mucous membrane of the channel.
Frequent stools, leading to fatigue sphincter muscle, corrosive effects of liquid feces, the presence of undigested food - all this creates conditions or causes of minor injuries. The breakdown of the mucous membrane of the hemorrhoid, fissures, inflammation of the lining of the anal canal at the proctitis especially can cause the development of acute paraproctitis.
Prevention paraproctitis - primarily the treatment of chronic constipation, as well as the prevention and timely treatment activities aimed at combating hemorrhoids, anal fissures, etc.
A few words about chronic paraproctitis.
After opening acute paraproctitis, due to the fact that its source (internal hole in the rectum) is not lifted, remains, as a rule, rectal fistula. It is usually displayed on the crotch near the anus. And no matter how much was made of surgical interventions concerning such fistula until it is abolished internal hole in the rectum, the disease will recur.
Rectal fistula is characterized by the presence near the anus one or more of the outer holes, from which stand out the pus, sometimes fecal and gases. With long-term existence of such a fistula arise maceration of the skin and irritation around the anus.
While fistula functions (external his hole open), relapses of acute paraproctitis are rare. But there is a special form of the so-called recurrent acute paraproctitis. Under him, the point of the inner hole in the rectum is temporarily closed with a soft scar, and fistula stops functioning. There comes the apparent recovery. But at the slightest injury to this tripe paraproctitis recurs.
Fistulas are of four kinds, depending on the location of fistulous progress towards the sphincter muscle (it determines the choice of surgical treatment method).
1. Subcutaneous submucosal or intersphincter, fistulas - fistular course is located immediately below the mucosa, or in the subcutaneous tissue (medially from the sphincter muscles).
2. Krestintern - fistular the course is directed from the intestine to the outside through the belly of the sphincter muscle.
3. Complex or ekstrasfinkternye, - fistular channel from the rectum around the sphincter with the outside. The bore is typically located at the upper pole of the sphincter.
Complex fistula quite often u: one inner hole located on the back wall of the rectum, go through the sphincter (or out of) two fistulous moves that appear on the skin of the two holes on both sides of the anus.
4. Incomplete fistula have only internal hole in the rectum. Fistulous course this goes in the submucosa in the sphincter muscle. Sometimes ends up in the tissue, located behind the rectum. Incomplete fistula not have outer hole in the crotch. The source of their education is often a chronic fissure.
Due to the lack of outside openings to find incomplete fistula difficult. The only sign indicating its presence can be small purulent discharge from the anus, and sometimes only itching in this area.
Treatment of all types fistula surgery. Success is determined by how radically impossible to liquidate an internal aperture.
If fistulous move simple and is medially from sphincter (subcutaneous submucosal fistula), then in most cases it is enough to enter into his outer hole thin pugovicy probe passes into the lumen of the intestine through an internal aperture. In these cases it is possible to probe beneath the skin of the cords coming from the external opening into the lumen of the intestine to one of the crypts (rear, front or side), where the inner opening.
Unlike subcutaneous and krestintern fistula when ekstrasfinkternye fistula probe entered in the outer hole, goes up in parallel intestine outward from the sphincter.
Surgical treatment pryamokishechnye fistula, we repeat, is a complicated surgery. The operation can only be radical in that case, if Jari excision fistulous progress will be liquidated inner opening.