Paraproctitis

Paraproctitis (paraproctitis; from the Greek. para - around, around and proktos - anus)- acute or chronic inflammation of tissue surrounding the anus and rectum. The term "paraproktit" cannot serve as a synonym paraproctitis, as they determine the inflammation serous cover of the authority.
Acute paraproctitis flows with the formation of abscesses or cellulitis. Ill mainly people aged 20 to 50 years; children paraproctitis is very rare. Sick mainly men, as they are more likely than women prone to diseases that can be complicated P. - anal fissures, especially hemorrhoids. According to A. M. Aminova preceding hemorrhoids was observed in 25% of patients with acute P. Predisposing importance features of the structure of the anus (see) and rectum (see) - morganii crypts with flaps, numerous anal glands. The importance of all the moments that can cause injury to the mucous membrane of the rectum is bulky, heavy stool (for constipation) or plenty of them in solids, diarrhea, mnogomomentnym the act of defecation, etc.
When inflammation koprovyh glands, we have to stop spreading, phlegmon buttocks (sometimes after injection), prostatitis, parauretral abscess, parametritis, osteomyelitis pelvic infection can spread to the pararectal cellular tissue. Often a source of paraproctitis are a boil, diaper rash eczema, abrasion in the anus, etc.
The causative agents of acute paraproctitis - often polymicrobial flora - E. coli and cocci, less often only cocci. Rarely detect TB bacilli and anaerobes. Microbes invade the tissues usually damaged areas of the mucosa in the area of crypts or through inflamed skin.

the main types of paraproctitis
Fig. 1. The main types of paraproctitis: 1 - subcutaneous; 2 - sciatic-pryamokishechnye; 3 - pelvic-pryamokishechnye; 4 - submucosal. (5 - paraproktit, abscess red space).

The following types of acute P. (Fig. 1): subcutaneous (perianalny);
sciatic-pryamokishechnye (ESIA-rectal); pelvic-pryamokishechnye, or podbroshennye (pelviureteric, or subperitoneal); submucosal. Rare varieties of these forms are retroactively and interestly P., slightly more common horseshoe P., which encircles the intestine mostly from behind and refers to ileorectal P.
To begin acute paraproctitis usually characterized by acute onset. Pain in the anus or rectum, stool retention without delay gases. In rare cases, there diarrhea (due proctitis). The dehiscence of the sphincter, fever, change in blood - moderate leukocytosis and acceleration ROHE, loss of sleep, appetite, health, General fatigue.
Subcutaneous paraproctitis found in 56.6% of the total number of P. it is characterized by pain in the anus, aggravated by defecation and complicating walk. Sit patients can only healthy gluteal region. In the case of the front localization ulcer possible dysuric disorders. The chair is often delayed. Sometimes there are painful and fruitless urge to have a bowel movement and a gaping sphincter with mucus. Palpation around the anus deep in the subcutaneous fat easily palpated sharply painful infiltrate, then appear inflammatory swelling and redness. Radial wrinkles are smoothed. Deformed anal area. Later you can feel softening and fluctuation. While inserting your finger into the rectum, which is possible when pressed on the healthy side, is determined by the absence of changes in the intestine. In the future, the process can be distributed in ileorectal space, but more often on 3-5-8-day revealed themselves through the mucous membranes or the skin.
Sciatic-pryamokishechnye paraproctitis often begins acutely, accompanied by chills, a significant increase in temperature, but may develop more slowly.


Fig. 2. The main ways of spreading and self breakthrough paraproctitis: 1 - subcutaneous; 2 - sciatic-pryamokishechnye.

Pain deep in the pelvic area are amplified when urinating. When localization in front semicircle ulcers observed dysuric disorders. When localization in the back of the semicircle pain sometimes iradionet on the sciatic nerve. In the first days visible to the eyes there are no changes. Only during the examination of the rectum finger revealed sharply painful infiltrate that stuck out later in the bowel lumen, softens and fluctuates. Pus can break into the subcutaneous tissue (Fig. 2), to cause the symptoms of subcutaneous paraproctitis or another sciatic-pryamokishechnye hole, then comes back P. u Less pus propodaet the muscle that raises the anus and into the pelvic-pryamokishechnye space, Front horseshoe P. extremely rare. Spontaneous breakthrough ulcer in ileorectal the paraproctitis usually occurs at the end of the second week mostly in the bowel lumen, through one of the rear of the crypts.


Pelvic-pryamokishechnye paraproctitis - the most dangerous form. Clinical phenomena remind sciatic-pryamokishechnye paraproctitis and usually develop gradually. When this fever and other common disorders are often ahead of the development of local symptoms. Pain felt in the depth of the lower abdomen, or pelvis, iradionet in the thigh, the bladder, the sacrum. Defecation is often not broken. The abscess breaks up spontaneously in the rectum, but it can cause severe intoxication and threatening sepsis.
The diagnosis revealed only in the study of the rectum with a finger. The lower edge of the dense, painful infiltrate, vypyachivalis in the intestinal lumen. The upper border infiltration unattainable finger. Infiltrate can have some mobility, unlike ileorectal paraproctitis.
Submucosal paraproktit are rare. Limited abscess does not cause pulsing pain, has little effect on the overall health of the patient. Pain moderate. Dysuric disorders does not happen. Bowel movement painful. Your finger is determined by a collection of pus in the form of painful swelling of the lining of the rectum. P. may develop slowly, with minor manifestations, sometimes the wavy. Months, sometimes years, before the abscess will be opened or exposed slit. Such a trend is characteristic of tuberculosis, aktinomikoz, Coccidioides and syphilitic paraproktit.
Treatment of acute paraproctitis only at the very beginning of the disease may be conservative (introduction to the tissue surrounding infiltration, novocaine with antibiotics, warmth, peace).
Surgery't wait. The operation should be performed after the first sleepless night, even if the infiltration is defined clearly or if the abscess is already proved themselves. After promptly opened ulcer wound is completely cured in most patients. After self-abscess-cutting steadfastly recover only about 1/3 of the patients.
Anesthesia - Rausch, General anesthesia, which if necessary can be somewhat continued. The incision is always necessary to make a broad, that it provides a good outflow and warned the formation of fistulas. You should carefully to avoid damage to the sphincter of the rectum. In subcutaneous paraproctitis an incision in the skin over the infiltration in the form polubogi. Permissible radial incisions with small limited superficial ulcers, located about anal ring. If you study the wounds detected thinning the mucous membrane in the line of the rear crypts, it is advisable excision of the skin and mucous membrane over purulent cavity in the form of a triangle (Gabriel), the summit aimed to the crypt, and base - outwards (see Fig. 6 tbsp. the anus), without dissection of the sphincter.
Sciatic - pelvic-pryamokishechnye paraproctitis often combined. To ensure their sometimes you can apply the same techniques. Deep unstarted ulcers dotted line from the bowel lumen when introduced rectal mirror, then the needle is widely open longitudinal incision. Enter three days rubber drainage, the end of which will endure from anus. In subsequent gaping wounds check with your finger with dressings. The wound ulcer usually heals completely, rarely formed internal fistula.
When distributing deep paraproktit on subcutaneous tissue with all the signs of subcutaneous abscess access from the lumen of the intestine is not applicable. These extensive ulcers should be open wide arched skin incision through infiltration, some distance from the back passage 3-4 see Tissue in the depth of pushing only stupid, it is better finger, especially when the location of the abscess is closer to the front, for fear of damage to the urethra (in men). U posedproven ulcer open wide curved slit crossing anal PC bundles. The cavity is filled with tampons with Vishnevsky ointment.
Podslizistom ulcers wide vertical incision above the largest swelling cut through the mucous membranes. The wound is drained by 1-2 days gauze strips, cotton Vishnevsky ointment or any other ointment.
Bandaging the first 5-8 days do every day as getting wet bandages. During bandaging it should be plenty to irrigate the wounds of hydrogen peroxide or furatsilina 1 : 5000. With 5-8 days before bandage, usually after a chair, do sit-warm bath with a solution of potassium permanganate.
After opening of abscess from the bowel lumen and the introduction of rubber drainage to remove the last to detain chair of the appointment of the interior of tincture of opium 5-6 drops 3 times a day for 2-3 days.