Paraproctitis is an inflammation of the tissue surrounding the rectum (the pararectal cellular tissue).
There are three fasciale-fiber space: subcutaneous, ileorectal and pelvic-pryamokishechnye. Accordingly, paraproktit are subcutaneous, ileorectal and pelvic-pryamokishechnye.
Paraproctitis caused by an infection, which penetrates into the tissue of the rectum. This occurs when the rectum (usually in one of morganii crypts) is formed defect, through which the infection is easy to fall into the tissue surrounding the rectum. This defect is often small, literally point, the gap mucous membrane caused by injury (swallowed meat or fish bone and so on), a little strain of internal hemorrhoid, the fissures, etc.,
The clinical course paraproctitis is divided into acute and chronic. Acute paraproctitis is an abscess pararectal cellular tissue. Chronic paraproctitis - pararectal cellular fistularemaining after spontaneously revealed abscess or after opening of acute paraproctitis surgery. In any case, the pararectal cellular fistula begins in the rectum defect mucous membrane, which is its internal aperture.
Peculiarities of the clinical course of acute paraproctitis determined by which of fasciale-cellular tissue areas affected.
In subcutaneous paraproctitis abscess is formed in the subcutaneous fat. Near the anus, you receive the seal and pain. The temperature usually rises to 37,5-38 C (when the abscess formed, may be higher). During the inspection of the anus easily determined seal with redness, and in the presence of abscess - fluctuation.
The treatment of such paraproctitis - surgical. However, if the seal is small, has just appeared, accompanied by a slight rise in temperature, you can try to eliminate the process conservative method.
To this end are appointed hot (37-38 C) manganese bath for 15-20 minutes After the bath in the rectum is entered candle. To the rear passage is a compress of ointments. Candle before the introduction liberally greased the same ointment.
Because of the pain in the anus, the defecation may be incomplete, remaining a stool in the rectum hinder the resolution of the inflammatory process. To avoid this, you should call the chair using a cleansing enema. Laxatives to take is not recommended, as loose stools may enhance the penetration of the infection and exacerbate the process.
If these measures do not take effect, infiltration increases and the temperature rises, the only method of treatment is surgical.
Over infiltrate from outside of the anus is another incision of the skin in length, usually 2 - 2,5 cm, opened the abscess that produces pus. The remaining cavity thoroughly washed with 3%-s ' solution of peroxide of hydrogen, musiruyutsya 1%iodine solution, then is injected into the cavity swab with ointment and over, put a compress with this ointment.
However, this surgery in the majority of cases, the wound is fully healed, remains fistula with an internal aperture in the rectum and outer hole in the scar on the former site of the wound.
To avoid formation of such a fistula in subcutaneous paraproctitis, it is possible to expand the operation, not limited to only one opening an abscess. Into the cavity, emptied from pus, outside of the anus is entered globality probe that should easily, without any effort, to go into the lumen of the intestine through an internal aperture. On this globulinom probe (pre rectum is entered rectal mirror) dissects the inner wall of the abscess. Thus, it turns out the wound opened in the intestinal lumen. It is cleared from necrotic tissue, the edges of her refreshed (especially in the field of internal apertures).
Radical surgery is possible because when a skin paraproktit abscess is located, as a rule, medially from the sphincter muscle. At the opening of abscess cut mucosa only partially affects her.
We emphasize, this operation can be performed only by being strongly convinced that paraproctitis it is subcutaneous. Lancing of abscess in the lumen of the intestine with the other types of paraproctitis (ileorectal, pelvic-pryamokishechnye)when the abscess is located outwards from the muscles, can significantly disturb the function of the sphincter.
When ileorectal the paraproctitis also appears dull pain in the anus, the temperature rises up to 38o C. There is a General malaise. Near the anus can be determined fairly extensive seal (redness usually not the case). More often this seal is found in the finger rectal. It will wybuchem in its ground clearance, a study of the causes of sharp pain.
The only method of treatment is surgery. Outside of the anus on the affected side, an incision is made in the form of semi-circle surrounding the anus. Cut the skin, subcutaneous tissue, fascia (up to ileorectal depression), opened the abscess. Dissection deep layers should be carried out under the control of the finger inserted into the rectum, which helps to detect the abscess.
The cavity is cleared from pus, washed with 3%-s ' solution of peroxide of hydrogen, with an antibiotic solution, then it introduces the swab with ointment.
Pelvic-pryamokishechnye paraproctitis is the most severe form of the disease.
Abscess in this case is high, under the pelvic peritoneum. The condition of patients is very heavy, the Temperature rises to 40 degrees, there are phenomena deep intoxication. On the background of this state of local signs are very slim that often misleading. Can occur assumptions about the pneumonia, or any infectious disease.
In doubtful cases, along with other methods of examination produce digital examination of the rectum. In view of the difficult condition of the patient, it can take place in the supine position (legs bent at the knees and hip joints). If there ulcer, located high in the pelvic-pryamokishechnye the tissue that is bulging into the lumen of the intestine may be missing, but when finger study inevitably causes acute pain radiating in the pelvis.