What is acute paraproctitis? Paraproctitis - what it is, types, causes, symptoms, treatment of acute and chronic paraproctitis in adults. What contributes to the formation of the disease

Paraproctitis is a fairly common disease throughout the world, as evidenced by statistics. About a quarter of all proctological diseases are caused by inflammation of the tissue located near the rectum. Symptoms of paraproctitis, especially its acute form, are accompanied by general intoxication, pain in the lower abdomen, the appearance of a tumor, fever, difficulty urinating and defecating.

The disease is inflammatory process fiber, most often affecting representatives of the stronger sex. Inflammation must be treated with the help of a specialist. Otherwise it goes to chronic form, there is a threat of complications (transition of inflammation to other organs, opening of a purulent abscess).

Paraproctitis in any form can cause a lot of suffering to a person. The sphincter is most often affected by complications. More precisely, the locking ability of the sphincter.

The root cause of the disease is infection (Escherichia coli, staphylococci, streptococci) that enter the cellular space from the rectum. Any wounds, household injuries and microtraumas, surgery on the mucous membrane are the entrance gates for such infections.

Staphylococci and streptococci penetrate into the cellular space not only through cracks in the rectal mucosa. There is an internal path: caries, sinusitis or any other source of sluggish (chronic) infection. With the flow of blood and lymph, pathogens from the epicenter of inflammation are transferred to other organs and tissues.

Another way pathogens penetrate the cellular space is by blocking the anal gland duct.

The appearance of the disease is favored by poor nutrition, a sedentary lifestyle and the presence of low-grade inflammatory processes. Additional aspects that increase the risk of the disease:

weakened immune system;
diabetes;
vascular atherosclerosis;
anal intercourse;
fissures in the anus.

In particular severe manifestations inflammation of the disease can cover several areas located near the intestines at once.

First signs

Paraproctitis can be acute or chronic type. Clinical picture and the symptoms of both forms of manifestation of the disease differ.

Spicy

The disease during its acute manifestation can be characterized by symptoms of a common inflammatory phenomenon in the body. As a rule, body temperature rises (sometimes up to 390), weakness, muscle, joint and headache appear, and appetite disappears. The passage of feces and urine is disrupted: unnatural desires to defecate appear, constipation occurs, urination becomes more frequent and becomes painful.

Symptoms of paraproctitis directly depend on where the inflammation is localized. The subcutaneous form of paraproctitis is distinguished by the fact that the affected area is visible to the naked eye: the skin turns red, swells, the tissue is compacted, there is a tumor near the anus, in the anus. The patient cannot sit due to pain and therefore immediately seeks help from a doctor. The disease most often manifests itself in the subcutaneous form. When pressing and palpating, severe pain is felt. This is how the disease manifests itself in children.

Submucosal paraproctitis symptoms are similar to subcutaneous view. The differences are that the body temperature does not rise much and the pain is not so pronounced. The abscess is located near the intestines and breaks into the rectum.

Difficulties in making the correct diagnosis arise with the pelvic-rectal form of the disease. They are due to the same symptoms for all forms of infectious diseases. The patient seeks help from various specialists; there are often cases when patients independently begin to treat what they consider to be a common respiratory disease. The focus of this form of paraproctitis is deep, on the border abdominal cavity and muscles pelvic floor.

This inflammation can last up to two weeks. During this time, the patient notes a noticeable deterioration in the condition of his own body. During defecation, in addition to feces, blood and pus are observed. At the same time, the temperature decreases and the severity of the pain syndrome decreases. This is how an abscess that opens directly into the rectum manifests itself. Representatives of the fairer sex often feel an abscess bursting into the vagina, and pus mixed with blood appears from the perineum.

Danger arises if a purulent abscess breaks into the abdominal cavity, causing peritonitis. Or into the intestines, which will lead to a more favorable outcome.

The ileo-rectal type of paraproctitis is characterized by the appearance specific symptoms only on the seventh day. The course of the disease is characterized by difficulty in making a diagnosis in the first days. Only after a week has passed, the skin near the epicenter of inflammation turns red and swollen, and the buttocks become different sizes.

The most dangerous for the patient is necrotizing paraproctitis. This type is characterized by instant intoxication, severe pain covering the entire perineum. In this case, low blood pressure, increased heart rate and cyanosis are observed. skin ov. The soft tissue dies. The process is not accompanied by redness and the appearance of pus; instead, necrosis and strong gas formation– rotting with the release of “swamp” gas.

Necrotizing paraproctitis develops due to damage by putrefactive microbes, clostridia, fusobacteria, and anaerobic microorganisms.

If the abscess is opened by the patient himself or the course of treatment is chosen incorrectly, acute paraproctitis easily turns into chronic.

Doctor speaking! Under no circumstances should you self-medicate! This will only accelerate the transition of an acute purulent process into a chronic form, aggravate the condition, and will also contribute to the appearance of complications and tumors in the body.

Chronic

A condition in which there is a fistula in the anus and a constant inflammatory process is called chronic paraproctitis. For the most part, chronic paraproctitis is painless.

Most common reason, due to which clinical paraproctitis occurs - improper treatment of it acute form or delay in seeing a doctor. The main complications that distinguish chronic paraproctitis are:

fistula on the skin in the anus and buttocks;
pus and feces are released from the fistula tracts;
irritation and itching of the skin in the area of the fistula;
pain during bowel movements.

The clinical picture of chronic paraproctitis can be characterized by alternating remissions and exacerbations of the disease. If the disease is not treated, consequences such as fecal incontinence and inflammation of the rectum are possible. If pus breaks through into the pelvic tissue, the sick person may die.

At the stage of remission of the disease, the patient only notices the discharge of pus mixed with blood and feces from the fistula canal in the anus. If the fistula cavity is not clogged, then the pain does not bother you. When the canal becomes clogged, an abscess appears in the perineal area, during the development of which new fistulas are formed. If the disease is severely advanced, branched fistula canals arise with a common epicenter in which the infection nests.

When the fistula channel is poorly drained, symptoms of acute paraproctitis are observed. During acute period disease, a new fistula is formed.

Doctor speaking! Chronic paraproctitis cannot be cured on its own. Each relapse worsens the disease and leads to tissue necrosis and the appearance of malignant tumors.

Paraproctitis – dangerous disease, which should not be launched under any circumstances. The chronic form of paraproctitis is difficult to treat. For this reason, it is important not to transform the disease into chronic stage.

Treatment

Treatment methods for paraproctitis are not varied. More precisely, there is only one method of cure - surgery. With its help, the clinical manifestations of chronic and acute purulent paraproctitis are effectively cured.

Important! The operation serves as the only salvation and deliverance for the patient in the fight against acute and chronic paraproctitis.

The operation is performed under general anesthesia. Moreover, it is carried out surgery immediately upon delivery accurate diagnosis. Acute paraproctitis is treated as follows:

the abscess is opened surgically;
the abscess cavity is drained;
overlap possible ways penetration of infection into the fiber tissue.

Only after carrying out the above measures is it possible to cure the patient’s acute form of paraproctitis.

The chronic form of the disease is treated conservatively if there is an exacerbation of inflammation. This is done in order to eliminate the abscess. The patient receives antibiotics and physical therapy. Next, an operation is performed to excise the fistula.

The operation is not performed during persistent attenuation of the inflammatory process. Because in this case, it is very difficult to identify the fistula among the tissues around it.

The operation is most often carried out in several stages, since opening the abscess, removing the contents of the abscess and installing drainage cannot serve as a 100% guarantee of cure. The effect of the disease is removed, but not its cause. Therefore, after a week, the second stage of the operation is carried out: the diseased sinuses and glands are removed.

In rare cases, both stages of surgical treatment are performed simultaneously. To carry out such an operation, you need to know exactly where the abscess is located, and the tissue around the source of inflammation should not be infected.

If the abscess is deep, the sphincter is cut, which increases the likelihood of damage to the anal closure device. As a result, a postoperative complication may occur - fecal incontinence.

To treat the chronic form of paraproctitis, the following surgical methods are used:

Removing the fistula is the most effective method. But the risk of sphincter insufficiency is high, postoperative wounds heal slowly, and complications often arise.
Removal of the fistula with placement of a “patch” of intestinal tissue at the site of excision. The operation is quite effective and is usually done if the fistula canal is wide. Complications often include dysfunction of the sphincter.
On early stages disease, the most effective method is to introduce a sealing tampon from animal intestinal tissue. There are no problems with the sphincter.

Which operation will be most effective for each specific patient is decided by the proctologist after a detailed analysis of all the symptoms of paraproctitis.

After surgical treatment of paraproctitis, a course of antibiotics is necessarily prescribed, dressings are made using antiseptic drugs. Full recovery the patient occurs after five weeks. At this time, the patient must follow the doctor’s recommendations.

This video talks about the treatment of paraproctitis

Complications

The occurrence of complications becomes possible during acute and chronic course diseases. The most common of them are:

Assimilation of the membranes of the rectum, urethra, vagina with pus.
Promotion of inflammation to the pelvic and pararectal tissue, as well as from one cellular space to another with instant infection of the tissue.
Opening of an abscess into the abdominal cavity with the formation of peritonitis and onto the surface of the skin.
Periodically occurring inflammatory processes with the formation of scars, which leads to stenosis and deformation of the anus and sphincter and ultimately leads to sphincteric insufficiency.

The course of paraproctitis in children can be characterized by the same symptoms as in adults: heat, muscle and joint pain, intoxication, loss of appetite.

Paraproctitis in children often manifests itself in a subcutaneous form. The most common pathogen in children infancy is staphylococcus, which penetrates through diaper rash and causes the occurrence of a subcutaneous type of illness.

Important! Weakened immunity, combined with an imbalanced intestinal microflora, increases the likelihood of paraproctitis in children significantly.

Video about complications of paraproctitis in children

Prevention

The most important thing after the long-awaited recovery is to prevent re-development illness. Relapse prevention measures are as follows:

A special diet to prevent constipation and diarrhea.
Maintaining body weight within normal limits.
Haemorrhoids, anal fissures, as well as any centers chronic infection, including caries, hepatitis, tonsillitis, pharyngitis, sinusitis must be destroyed.
Hygiene must be at the highest level: After each bowel movement, washing is necessary.
Diabetes mellitus, gastrointestinal diseases, atherosclerosis contribute to the appearance of the disease and therefore must be treated.

It is easier to prevent any disease than to treat it later running form having suffered enough of the symptoms.

Important! Having taken up the prevention of paraproctitis, you need to Special attention pay attention to ailments of the gastrointestinal tract, since problems in the functioning of this area serve as an impetus for the onset of the disease.

The general condition of the body is of paramount importance in the appearance and course of any disease process.

As a preventative measure, you should not get too involved in strength sports and weight lifting.

It is best to minimize the use of enemas and various laxatives.

You need to try to prevent blood stagnation in the pelvic area.

Eating enough plant fiber ensures regular bowel movements. As a stool softener, it is recommended to drink at least one and a half liters of clean water per day.

Paraproctitis(perirectal abscess) - acute or chronic inflammation of adirectal tissue. It accounts for about 30% of all diseases, the process affects approximately 0.5% of the population. Men suffer 2 times more often than women; they get sick at the age of 30-50 years.

Etiology and pathogenesis. Paraproctitis occurs as a result of microflora (staphylococcus, gram-negative and gram-positive bacilli) entering the perirectal tissue. With ordinary paraproctitis, polymicrobial flora is most often detected. Inflammation involving anaerobes is accompanied by particularly severe manifestations of the disease - gaseous cellulitis of the pelvic tissue, putrefactive paraproctitis, anaerobic sepsis. Specific pathogens of tuberculosis, syphilis, actinomycosis very rarely cause paraproctitis.

The routes of infection are very diverse. Microbes enter the perirectal tissue from the anal glands, which open into the anal sinuses. During the inflammatory process in the anal gland, its duct is blocked, an abscess is formed in the intersphincteric space, which breaks into the perianal or pararectal space. The transition of the process from the inflamed gland to the perirectal tissue is also possible through the lymphogenous route.

In the development of paraproctitis, injuries to the rectal mucosa by foreign bodies contained in feces, hemorrhoids, anal fissures, ulcerative colitis, Crohn's disease, and immunodeficiency conditions can play a certain role.

Paraproctitis can be secondary - when the inflammatory process spreads to pararectal tissue from the prostate gland, urethra, and female genital organs. Rectal injuries are a rare cause of paraproctitis (traumatic).

Classification of paraproctitis

Acute paraproctitis.

According to the etiological principle: ordinary, anaerobic, specific, traumatic.

According to the localization of abscesses (infiltrates, leaks): subcutaneous, ischiorectal, submucosal, pelviorectal, retrorectal.

Chronic paraproctitis (rectal fistulas).

According to anatomical characteristics: complete, incomplete, external, internal.

According to the location of the internal opening of the fistula: anterior, posterior, lateral.

In relation to the fistula tract and the sphincter fibers: intrasphincteric, transsphincteric, extrasphincteric.

By degree of difficulty: simple, complex.

Acute paraproctitis characterized by rapid development of the process.

Clinically, paraproctitis is manifested by quite intense pain in the rectum or perineum, increased body temperature, accompanied by chills, a feeling of malaise, weakness, headaches, insomnia, and loss of appetite. Extensive phlegmon of the perirectal tissue leads to severe intoxication, the development of a syndrome of dysfunction of vital organs, threatening the transition to multiple organ failure and sepsis. Stool retention, tenesmus, and dysuric phenomena often appear. As pus accumulates, the pain intensifies, becoming tugging and pulsating. If the abscess is not opened in a timely manner, it breaks into adjacent cellular spaces, the rectum, and out through the skin of the perineum.

A breakthrough of an abscess into the rectum is a consequence of the melting of its wall with pus during pelviorectal paraproctitis. A connection is formed between the abscess cavity and the lumen of the rectum (incomplete internal fistula).

When pus breaks out (on the skin of the perineum), an external fistula is formed. The pain subsides, body temperature decreases, and the patient’s general condition improves.

A breakthrough of an abscess into the lumen of the rectum or outwards very rarely leads to a complete recovery of the patient. More often, a fistula of the rectum (chronic paraproctitis) forms.

Subcutaneous paraproctitis is the most common form of the disease (up to 50% of all patients with paraproctitis). Characterized by sharp, jerking pains that intensify with movement, straining, and defecation; dysuria is observed. Body temperature reaches 39 "C, chills often occur. On examination, hyperemia, swelling and bulging of the skin in a limited area near the anus, deformation of the anal canal are revealed. When palpating this area, sharp pain is noted, sometimes fluctuation is detected. Digital examination of the rectum causes increased pain. However, it is advisable to carry it out under anesthesia, since this makes it possible to determine the size of the infiltrate on one of the walls of the rectum near the anal canal and make a decision on the method of treatment.

Ishiorectal paraproctitis occurs in 35-40% of patients. Initially, general signs of a purulent process appear, characteristic of the systemic reaction to inflammation syndrome with a sharp increase in body temperature, chills, tachycardia and tachypnea, and a high level of leukocytes in the blood. Along with this, weakness, sleep disturbances, and signs of intoxication are noted. Dull pain in the depths of the perineum becomes sharp and throbbing. They intensify with coughing, physical activity, and defecation. When the abscess is localized anterior to the rectum, dysuria occurs. Only 5-7 days after the onset of the disease, moderate hyperemia and swelling of the skin of the perineum in the area where the abscess is located is noted. Noteworthy are the asymmetry of the gluteal regions and the smoothness of the semilunar fold on the affected side. Pain on palpation medially from the ischial tuberosity is moderate. Digital examination of the rectum is very valuable in the diagnosis of ischiorectal ulcers. Already at the beginning of the disease, it is possible to detect soreness and hardening of the intestinal wall above the rectal-anal line, smoothness of the folds of the rectal mucosa on the affected side.

Submucosal paraproctitis observed in 2-6% of patients with acute paraproctitis. The pain in this form of the disease is very moderate, somewhat intensifying with defecation. Body temperature is subfebrile. Palpation determines a bulge in the intestinal lumen, in the area of the abscess, which is sharply painful. After spontaneous breakthrough of the abscess into the intestinal lumen, recovery occurs.

Pelviorectal paraproctitis- the most severe form of the disease, occurs in 2-7% of patients with acute paraproctitis. Initially, general weakness, malaise, increased body temperature to subfebrile, chills, headache, loss of appetite, aching pain in the joints, dull pain lower abdomen.

When the infiltrate of pelviorectal tissue abscesses (7-20 days from the onset of the disease), the body temperature becomes hectic, and symptoms of purulent intoxication are expressed. The pain becomes more intense, localized, tenesmus, constipation, and dysuria are noted. There is no pain on palpation of the perineum. The diagnosis can be confirmed by ultrasound, computed tomography or magnetic resonance imaging. Without instrumental studies, it is difficult to make a diagnosis until purulent melting of the pelvic floor muscles leads to the spread of the inflammatory process to the ischiorectal and subcutaneous fatty tissue with the appearance of swelling and hyperemia of the skin of the perineum, pain when pressing in this area. During a digital examination of the rectum, infiltration of the intestinal wall, infiltration in the tissues surrounding the intestine and its bulging into the intestinal lumen can be detected. The upper edge of the bulge cannot be reached with a finger.

Retrorectal paraproctitis observed in 1.5-2.5% of all patients with paraproctitis. Characterized by intense pain in the rectum and sacrum, which intensifies during defecation, in a sitting position, and when pressing on the tailbone. The pain radiates to the thighs and perineum. During a digital examination of the rectum, a sharply painful bulging of the rectum is determined. back wall. Of the special research methods, sigmoidoscopy is used, which is informative for pelviorectal paraproctitis. Pay attention to hyperemia and slight bleeding of the mucous membrane in the area of the ampulla, smoothing of folds and infiltration of the wall, the internal opening of the fistula tract when the abscess breaks into the intestinal lumen. For other forms, endoscopy is not needed.

Treatment. In case of acute paraproctitis, surgical treatment is performed. The operation consists of opening and draining the abscess, eliminating the entrance gates of the infection. The operation is performed under general anesthesia. After anesthesia (anesthesia), the localization of the affected sinus is established (inspection of the intestinal wall using a rectal mirror after introducing a solution of methylene blue and a solution of hydrogen peroxide into the cavity of the abscess). If the abscess breaks out through the skin, then, as a rule, good drainage does not occur.

In case of subcutaneous paraproctitis, it is opened with a semilunar incision, the purulent cavity is well inspected with a finger, the bridges are separated and purulent leaks are eliminated. A button probe is passed through the cavity into the affected sinus and an area of skin and mucous membrane that forms the wall of the cavity together with the sinus is excised (Gabriel's operation). For subcutaneous-submucosal paraproctitis, the incision can be made in the radial direction - from the pectineal line through the affected anal crypt (entry gate of infection) to the perianal skin. Then the edges of the incision and the affected crypt along with the internal opening of the fistula are excised. A bandage with ointment is applied to the wound, and a gas outlet tube is inserted into the lumen of the rectum.

With ischiorectal and pelviorectal paraproctitis, such surgical intervention is impossible, since a large part of the external sphincter will be crossed. In such cases, the abscess is opened with a semilunar incision, its cavity is carefully examined and all purulent streaks are opened, the wound is washed with a solution of hydrogen peroxide and loosely tamponed with a gauze swab with dioxidine ointment.

For retrorectal (presacral) acute paraproctitis, a skin incision 5-6 cm long is made in the middle between the projection of the apex of the coccyx and the posterior edge of the anus. The anal-coccygeal ligament is crossed at a distance of 1 cm from the coccyx. The pus is evacuated, the abscess cavity is examined with a finger, separating the bridges. Using hooks, the posterior wall of the anal canal, surrounded by the sphincter muscles, is exposed, where the area of the fistulous tract leading into the intestinal lumen is found. The second stage of the operation - carrying out the ligature - is performed in the same way as described above.

Chronic paraproctitis (rectal fistulas) occurs in 30-40% of all proctological patients. The disease develops as a result of acute paraproctitis and manifests itself as rectal fistulas. This occurs if there is an internal opening leading from the rectum into the cavity of the abscess. When chronic paraproctitis forms, the internal opening of the fistula opens into the lumen of the rectum, and the external opening - on the skin of the perineum. Gases and feces enter the fistula from the rectum, which constantly maintains the inflammatory process.

The reasons for the transition of acute paraproctitis to chronic are: late presentation of patients for medical care after spontaneous opening of the abscess; erroneous surgical tactics in the acute period (opening the abscess without sanitizing the entrance gate of the infection).

The fistula can be complete or incomplete. A complete fistula has two or more openings: an internal one on the wall of the rectum and an external one on the skin of the perineum. An incomplete fistula has one hole on the wall of the rectum, ending blindly in the perirectal tissue (internal fistula).

A rectal fistula, depending on its location in relation to the sphincter fibers, can be intrasphincteric, transsphincteric and extrasphincteric.

With an intrasphincteric fistula, the fistula canal is completely located medially from the rectal sphincter. Usually such a fistula is straight and short.

With a transsphincteric fistula, part of the fistula canal passes through the sphincter, part is located in the tissue.

With an extrasphincteric fistula, the fistula canal passes through the cellular spaces of the pelvis and opens on the skin of the perineum, bypassing the sphincter.

Clinical picture and diagnosis. The amount of purulent discharge from the fistula varies and depends on the volume of the cavity that it drains, as well as on the degree of the inflammatory process in it. With a wide fistulous tract, gases and feces can escape through it; with a narrow one, scanty serous-purulent discharge can occur. Episodic closure of the fistula leads to impaired drainage of the purulent cavity, accumulation of pus, and exacerbation of paraproctitis. This alternation of exacerbations and remissions is often observed in chronic paraproctitis; the duration of remissions can reach several years.

Pain occurs only during exacerbation of the disease, disappearing during the period of functioning of the fistula. During examination, attention is paid to the number of fistulas, scars, the nature and amount of discharge from them, and the presence of maceration of the skin. Already with palpation of the perianal zone it is often possible to determine the fistulous tract. Digital examination of the rectum allows us to determine the tone of the rectal sphincter, sometimes to identify the internal opening of the fistula, its size, establish the complexity of the fistula, its course and features.

Additional information about the localization of the internal opening of the fistula, its course and features, which is necessary for choosing a surgical method, is obtained by introducing methylene blue into the fistula, careful probing of the fistulous tract, fistulography, anoscopy, sigmoidoscopy, endorectal ultrasound.

Treatment. Conservative treatment includes sitz baths after defecation, washing the fistula with antiseptic solutions, introducing antibiotics into the fistula tract, and using microenemas with sea buckthorn oil and collargol. Conservative treatment rarely leads to complete recovery of patients, so it is usually used only as a preparatory step before surgery.

Surgical intervention is a radical method of treating rectal fistulas. The timing of surgical intervention depends on the nature of the disease: in case of exacerbation of chronic paraproctitis, urgent surgical intervention is indicated; in case of subacute paraproctitis (presence of infiltrates), anti-inflammatory treatment is carried out for 1-3 weeks, then surgical intervention; in case of chronicity - elective surgery; in case of stable remission, the operation is postponed until paraproctitis worsens.

Surgical intervention for rectal fistulas is carried out depending on the type of fistula (its relationship to the sphincter), the presence of inflammatory processes in the perirectal tissue, purulent leaks, and the condition of the tissues in the area of the internal opening of the fistula.

For intrasphincteric fistulas, they are excised into the lumen of the rectum. It is better to excise the fistula in a wedge-shaped manner along with the skin and tissue. The bottom of the wound is scraped out with a Volkmann spoon. If there is a purulent cavity in the subcutaneous fatty tissue, it is opened using a probe, the walls are scraped out with a Volkmann spoon, a gauze turunda with ointment (levosin, levomekol, etc.) is inserted, and a gas outlet tube is installed.

Transsphincteric fistulas are eliminated by excision of the fistula into the lumen of the rectum with or without suturing the deep layers of the wound (sphincter muscles) and draining the purulent cavity.

For extrasphincteric fistulas, which are the most complex, various operations are resorted to, the essence of which is the complete excision of the fistula tract and the elimination (suturing) of the internal opening of the fistula. For complex fistulas, the ligature method is used. Incomplete fistulas are excised into the lumen of the rectum using a probe bent at a right angle.

is in fourth place in terms of prevalence. Of the hundreds of sick patients who visited the doctor, about forty people were patients with paraproctitis, the photo of which you see below. Most often, the disease is diagnosed in the stronger sex.

To understand what it is: paraproctitis, and how to treat it, let’s look at the structural features of the rectum.

Paraproctitis

Near this organ there is a lot of cellular space, namely:

Ileorectal space.
Pelvic-rectal.
Posterior rectal.

All these are accompanying spaces that are located on different sides. Any of these parts are susceptible to inflammatory processes. Moreover, they very often extend to several areas.

As a rule, most often the disease begins to progress with damage to the crypt. Wherein Anal glands contribute to the spread of infection.

Etiology

Often, the development of the disease is facilitated by an infectious agent. Let's figure out why this happens: what are the causes of paraproctitis.

As a rule, the pathological process occurs under the influence of several pathogens at once: staphylococcal infection, streptococci, E. coli and many others.

Usually the infection penetrates between the cells from the anal area. The route of transmission can be through the blood or lymphatic system. The trigger mechanism for this process is:

Systematic.
Defeat hemorrhoids with the formation of wounds.

The infection can enter the body not only from the anal area, but also from any chronic infectious site. These could be carious teeth, sinusitis, etc.

In addition, damage to the anal area of a domestic or operational nature may be to blame.

The causes of chronic paraproctitis in men are not much different from the factors in the development of the disease in the female population. Due to the fact that men abuse alcohol more often and more, smoke, and their professional activity sometimes involves performing heavy physical efforts, these are the reasons are the main ones in the appearance of the disease.

Clinic for acute illness

This form of the disease is expressed by a sudden onset and intense clinical symptoms. External signs depend on the location of the pathological focus, its size, the properties of the pathogen and the general ability of the body to resist.

Subcutaneous paraproctitis

Some clinical manifestations are observed in all types of the disease:

Hyperemia with fever.
Symptoms of general poisoning, expressed by weakness, severe exhaustion, headache, reluctance to eat.
Problems with bowel movements and constipation, pain during bowel movements and urination.
Pain in the anal area varying degrees intensity, increasing during emptying.

Symptoms of acute paraproctitis by form

Each form of the disease is characterized by its own nuances. Symptoms of subcutaneous paraproctitis, the photo of which you see (see above), are expressed by intense redness of the skin, swelling and thickening of tissues, severe pain on palpation, inability to sit normally. Pathological areas are clearly visible outwardly, which forces patients to immediately consult a doctor.

The pelvic-rectal form is difficult to diagnose. The pathological process is observed in the lower part of the pelvis and is accompanied by general clinical signs.

People come to see therapists and proctologists, but the majority, unfortunately, choose the path of self-medication. This is due to the fact that the symptoms of the disease are perceived as respiratory infection. The patient’s well-being deteriorates sharply, manifestations of intoxication make themselves felt, pain increases, and serious problems with defecation and urination.

Often the state of health improves, pain goes away, temperature is restored, intense purulent bloody discharge appears from the anus,

Acute paraproctitis, the photo of the symptoms of which you see, is accompanied by just such signs. This occurs as a result of the breakthrough of purulent contents into the rectum. In the same way, an abscess can burst into the vagina in women.

Acute paraproctitis - treatment

It is worth noting that the symptoms of the ileorectal form of the disease are also nonspecific. Only a week after the development of the disease, local symptoms make themselves felt:

Redness of the skin.
Swelling.
Asymmetry of the buttocks.

All these symptoms give reason to suspect the presence of an acute form of paraproctitis. If a purulent abscess in the anus opens on its own, the disease can progress to the chronic stage of its course.

Pay attention to the pictures of paraproctitis, this is exactly what its external manifestations look like.

Manifestations of chronic paraproctitis

If the patient suffered an acute form and a fistula after paraproctitis, then they speak of the development of a chronic course of the pathology. This is a kind of formation with a channel opening outward. Through such an abscess near the anus in an adult, purulent contents are released. With complicated outflow, additional formations are formed.

Chronic paraproctitis is characterized by a lightning-fast course, alternating with relapses and remissions. During the period of calm, only discharge of a purulent-sanguineous nature is released from the fistula; there is often no pain. All these secretions irritate the skin, which can cause severe itching and irritation.

The period of exacerbation begins to develop when the lumen is closed with purulent contents. In this situation, all the signs of an acute form of the disease begin to worry.

A fistula cannot heal on its own, so seeking medical help is essential.

Therapeutic tactics

Treatment of paraproctitis symptoms involves surgery. Treatment of acute paraproctitis includes opening of purulent formation, its drainage and removal. This is the only way to achieve complete recovery.

But in reality, such a measure is carried out extremely rarely, because doctors do not always have sufficient experience. As a rule, when purulent paraproctitis, the photo of which you see, the formation is simply drained, after which it exists There is a huge chance of secondary infection.

Treatment of purulent paraproctitis

In case of exacerbation of chronic paraproctitis of the fistulous form, the treatment will be exactly the same. However, in patients with a similar diagnosis therapy must continue. Then they resort to surgical intervention for fistula removal.

Pay attention to the photo of the buttocks with paraproctitis before and after surgery.

Wound after paraproctitis

What consequences may arise

Complications can make themselves felt, both in acute and chronic forms of the disease. Often the disease is accompanied by the following complications:

Purulent lesions of the walls of the rectum.
Opening the abscesses outwards.
Spread of the inflammatory process to the pelvic tissue.
Development of peritonitis.
Spread of an abscess from one space to another.

Often relapses are caused by systematic inflammation with the formation of connective tissue. This promotes narrowing and modification anal area, and the development of its deficiency.

Prevention measures

Prevention of the disease is no less important than treatment of symptoms of paraproctitis in women and men. Photos of signs of the disease are presented below.

Paraproctitis is a disease that is characterized by purulent inflammation of the fatty tissue around the rectum and in the perianal area.

The main reason for its occurrence is the entry of pathogenic bacteria through the anal glands into the surrounding tissues. Paraproctitis can occur in acute and chronic forms.

First signs

Paraproctitis develops acutely. The person feels general malaise, headache and weakness. Through a short time increasing pain appears in the rectal area, which radiates to the perineum or pelvis. In this case, there is an increase in body temperature and chills.

Symptoms of the disease and the severity of pain depend on the location of the inflammatory process and the nature of the infectious agent.

When a purulent formation appears in the subcutaneous tissue, the symptoms are especially pronounced:

An abscess forms, accompanied by swelling of the skin.
The temperature rises significantly.
Skin hyperemia.
Severe pain occurs.

The severity of symptoms of paraproctitis, accompanied by tissue swelling and the appearance of infiltration, is usually observed on the 5-6th day, but maybe earlier. It depends on the individual characteristics of the body and the bacteria that caused the inflammation.

The most dangerous formations are those located deep in the pelvis. With them, a person is tormented by symptoms:

Strong headache.
Fever.
Increased body temperature.
Pain in the joints, lower abdomen, perineum.

Symptoms of paraproctitis in men and women are similar. If the formation is deep in the pelvis, the person will suffer for about 2 weeks general malaise, after which the pain in the rectal area increases significantly, stool retention and general intoxication of the body are observed.

General symptoms and signs:

Causes

The disease appears due to the penetration of pathogenic bacteria into fatty tissue and tissue from the rectum. This is often caused by anal fissures or other damage to the mucous membranes.

In rare cases, the causes of paraproctitis in men and women are associated with wounds and ulcers that appear on the surface of the skin. In men, inflammation of the representative gland can contribute to the disease.

In very rare cases, self-infection occurs when pathogenic bacteria are transferred through the bloodstream from other foci of inflammation.

People who have reduced immunity, diabetes mellitus, atherosclerosis, hemorrhoids and anal fissures are most susceptible to this pathology.

Other causes of occurrence in women and men are poor hygiene and.

Diagnostics

The disease is treated by a proctologist.

To make an accurate diagnosis, in most cases, a visual examination and digital examination are sufficient.

To eliminate the risk of complications, women are advised to visit a gynecologist, men - a urologist.

Treatment methods

Paraproctitis can only be treated surgically, regardless of its form. The operation is performed immediately after diagnosis. The surgeon’s task is to open the abscess and drain the cavity.

In addition, it is necessary to excise the tract through which the infection spreads. Otherwise, it will not be possible to achieve a complete recovery.

However, most surgeons do not perform tract excision due to lack of experience and skills. As a result, only the opening of the infiltrate and drainage of pus is performed. This may cause the formation of abscesses in the future or cause the appearance of a fistula.

After the operation, antibiotic therapy is indicated.

Paraproctitis (paraproctitis; from the Greek para - about, proktos - rectum; Latin itis - inflammatory process) is an acute or chronic inflammation the fatty tissue of the pelvis that surrounds the rectum. also in medical literature You can find the second name for this disease - pararectal abscess.

Often this pathological process accompanies hemorrhoids and occurs due to the penetration of pathogenic microorganisms into the pararectal tissues through damaged skin of the anus (ulcers, erosions, etc.).

Paraproctitis occupies a leading position in the structure of proctological diseases, second only to hemorrhoids in prevalence. Men, especially middle-aged men, are more often affected by this disease, but the appearance of purulent inflammation of perirectal fatty tissue in children and even infants is also possible.

Since this problem is quite relevant today, especially for those who are faced with hemorrhoids, we suggest considering what paraproctitis is, what are its causes, the first signs and symptoms. In addition, we will tell you what methods of treatment and prevention of this disease are offered by specialists, as well as traditional healers.

Anatomical features of the anorectal region

We will need knowledge of anatomy to better understand where, how and from what paraproctitis is formed.

The rectum (lat. Rectum) is a tubular organ 12-15 cm long, located in the pelvis, which is the final section digestive tract and opening on the skin of the perineum with the anus.

The wall of the rectum consists of four membranes: mucous, submucosal, muscular and serous (surrounded by fatty tissue).

In the pelvis, the following pararectal spaces can be distinguished, in which nerves, venous and arterial vessels pass:

ileo-rectal;
pelvic-rectal;
rectal;
subcutaneous;
submucosal.

Thus, pararectal abscesses are localized in the above spaces.

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Causes of the disease

The main cause of paraproctitis is the penetration of pathogenic microorganisms into the perirectal fatty tissue, both externally and from internal foci of chronic infection.

Pathogenic microorganisms can penetrate the fatty tissue surrounding the rectum, in several ways, namely:

hematogenous;
lymphogenous;
contact

Let us consider each route of infection spread to the perirectal fatty tissue in more detail.

Hematogenous spread of infection, that is, through the bloodstream, is more often observed with cryptitis, when the infectious agent penetrates the rectal gland, which becomes clogged and suppurates. From such an abscess, pathogenic microbes travel through the bloodstream into the fatty tissue that surrounds the rectum. In persons with weakened immune system the infection can spread to the pelvic area even from the sinuses, tonsils and teeth if there is an infectious focus in them.

It is also possible for the infection to spread through the lymphogenous route, when bacteria penetrate into the pararectal tissue from the inflamed rectum with the lymph flow.

The contact route of spread of infection is possible with injuries to the mucous membrane of the rectal canal, which arise due to entry into the stomach, and then into feces, sharp objects, or due to the presence of foreign objects.

Also, the entry point for infection can be damage to the rectal mucosa that occurs as a result of iatrogenic action during inaccurate diagnostic or therapeutic procedures.

In addition to the above, the infection can penetrate into the perirectal tissues from external environment through open wounds of the pelvis or spread from the inflamed prostate, urethra, ovaries and fallopian tubes.

Among pathogenic microorganisms that cause pararectal abscesses, first of all, anaerobes such as staphylococcus, streptococcus, Escherichia coli, Proteus and clostridia should be noted. But most often paraproctitis is the result of simultaneous exposure to several types of bacteria.

Less commonly, paraproctitis is caused by aerobes, for example, pseudomonas and Pseudomonas aeruginosa. The disease in such cases is characterized by a severe course and can lead to blood poisoning.

In addition, in rare cases, paraproctitis may have a specific etiology, that is, it may occur against the background of syphilis, tuberculosis, actinomycosis, gonorrhea, etc.

Risk groups and provoking factors

As is known, some of the above microorganisms are present in the intestines healthy person and do not cause paraproctitis.

Therefore, based on clinical observations, scientists have formed a number of provoking factors that contribute to inflammation of the perirectal tissue, which may include:

anal tears;
eczema of the anus;
immunodeficiencies that develop after a viral or infectious disease, as well as against the background of exhaustion of the body or chronic alcoholism;
endogenous foci of chronic infection (caries, sinusitis, tonsillitis and others);
diabetes;
atherosclerosis;
chronic constipation or diarrhea;
organ diseases genitourinary system(prostatitis, cystitis, adnexitis, urethritis, vaginitis and others);
chronic intestinal diseases (nonspecific ulcerative colitis, Crohn's disease);
anal sex.

Classification: types and forms of paraproctitis

Paraproctitis is usually distinguished by the form of its course, localization and etiology.

Depending on the characteristics of the course, paraproctitis can be acute or chronic. Acute paraproctitis is an acute purulent inflammation adipose tissue, which developed in the patient for the first time.

In turn, there are several forms of acute paraproctitis, which differ in localization, namely:

subcutaneous;
rectal;
ischiorectal;
submucosal;
pelviorectal;
necrotic.

Subcutaneous paraproctitis is characterized by purulent inflammation subcutaneous tissue perianal zone, which has a favorable prognosis when timely treatment.

Ischiorectal paraproctitis, also called sciatic, refers to the localization of a purulent-inflammatory focus in the ileorectal fossa, which also affects the levator rectal canal muscle.

Submucosal acute paraproctitis is a purulent inflammation of the submucosal layer of the rectal canal.

With pelviorecatal paraproctitis, the purulent focus is located inside the small bowl (pelvis) in the area of its border with the abdominal cavity.

Acute necrotizing paraproctitis is the most severe form of this disease, as it leads to large-scale necrosis of pelvic tissue and has a lightning-fast course.

According to etiology, acute paraproctitis can be classified into the following types:

nonspecific;
specific;
anaerobic;
traumatic.

Chronic paraproctitis is a purulent inflammation that affects almost all pararectal spaces and tissues (pararectal tissue, pararectal sinuses, space between the sphincters, etc.), characterized by a long course with periods of exacerbation and remission, as a result of which persistent epithelial ducts - fistulas - are formed.

Chronic paraproctitis is almost always the result of an acute form of the disease in the case of inadequate or incomplete treatment.

In the chronic course of paraproctitis, fistulas are formed, that is, epithelized passages that do not heal for a long time and connect the cavity of the pararectal abscess with the cavity of other organs, for example, the bladder, or open outward.

There are complete and incomplete, as well as internal and external fistulas. In addition, fistulas may differ in the location of the internal opening of the fistula: anterior, lateral, posterior.

Fistulas are also divided according to how they are located in relation to the anal sphincter, namely:

intrasphincteric;
extrasphincteric;
transfictional.

According to experts, the most common reason for the development of chronic paraproctitis is self-medication and late seeking medical help. Therefore, if you identify the first signs of a pararectal abscess, you should consult a proctologist.

Clinical features of acute paraproctitis

Although acute paraproctitis is called a pararectal abscess, it is not a banal purulent focus, like a boil or carbuncle. Paraproctitis in most cases leads to the formation of one or several purulent fistulas, the mouths of which are located near the anus or in the perianal zone closer to the buttocks.

For acute paraproctitis, characteristic acute onset diseases with bright severe symptoms. Character clinical manifestations and their intensity directly depends on the location and size of the purulent focus, as well as on the type of pathogen and the state of the patient’s immunity.

The onset of paraproctitis may be unnoticeable, since the patient has nonspecific symptoms, which are mainly associated with intoxication of the body by waste products of the pathogen.

The first signs of acute paraproctitis may be the following:

general weakness;
malaise;
headache;
increase in body temperature to 37.5°C and above;
chills;
excessive sweating;
myalgia (muscle pain);
arthralgia (joint pain);
decreased appetite;
dysuria (impaired urination);
tenesmus (painful urge to defecate);
pain during bowel movements;
pain when urinating;
pain in the lower abdomen;
pain in the pelvic area;
pain along the rectum;
pain in the anus.

The pain that accompanies paraproctitis has different intensity and localization, which depend on the form of the disease. Common to all forms of paraproctitis is increased pain during bowel movements.

The above symptoms are characteristic of all forms of the disease, but, nevertheless, each form of paraproctitis also has its own characteristics, so we suggest examining them in more detail.

Subcutaneous paraproctitis

Subcutaneous paraproctitis is characterized by the following symptoms:

hyperemia of the skin around the anus;
swelling of the tissues of the anus;
compaction under the skin of the anorectal area, which is very painful on palpation.

The pain with subcutaneous paraproctitis is so severe that patients cannot sit.

Rectal paraproctitis

Deep location of the purulent focus and general symptoms diseases create significant diagnostic difficulties. Very often, patients do not go to a proctologist, but to a gynecologist or general practitioner. Also, some patients attribute the symptoms of intoxication to a cold and engage in self-medication, which does not bring relief, but, on the contrary, the symptoms of paraproctitis only worsen.

Rectal paraproctitis is characterized by symptoms such as:

violation of the act of urination;
violation of the act of defecation;
purulent discharge mixed with blood from the rectal canal or even the vagina.

After the abscess breaks through, the patient feels a short-term improvement in his condition: normalization of body temperature, disappearance of pain, etc.

Ishiorectal paraproctitis

Ishiorectal paraproctitis is also difficult to diagnose and differentiate due to the fact that most of its manifestations are nonspecific and associated with intoxication of the body, and local signs appear only on the 5-7th day of illness.

Specific signs of ischiorectal paraproctitis are:

hyperemia of the skin over the purulent focus;
tissue swelling in the affected area;
asymmetry of the buttocks.

Submucosal paraproctitis

Submucosal paraproctitis is characterized by symptoms such as:

bulging of the rectal mucosa into the rectal canal over the perirectal abscess;
swelling of the rectal mucosa;
hyperemia of the rectal mucosa above the purulent focus;
compaction of tissue in the area of the abscess.

This form of paraproctitis is easy to diagnose.

Pelviorectal paraproctitis

Pelviorectal paraproctitis is considered the most severe form of the disease, since the purulent focus is localized above the pelvic floor and is separated from the abdominal cavity only by a thin sheet of peritoneum.

The disease begins with pronounced intoxication manifestations: increased body temperature to 38-40 ° C, chills, general weakness, increased sweating. In addition, the patient experiences pain in the pelvic area and lower abdomen.

Necrotic paraproctitis

Necrotic paraproctitis is characterized by the rapid spread of the pathogen through the tissues of the pelvis, which leads to large-scale necrosis of the soft tissues of the pelvis.

With this type of paraproctitis, patients complain of general weakness, temperature increase, severe pain etc.

Patients may suspect one or another form of paraproctitis based on the above symptoms, after which it is necessary to consult a proctologist to avoid complications and chronicity of the process. Also, experts do not recommend self-medication, as this does not always bring the expected effect and can even be harmful to health.

Clinical features of chronic paraproctitis

As mentioned earlier, chronic paraproctitis is the result of untimely, unfinished or improper treatment acute form of the disease.

Chronic paraproctitis is characterized by the same symptoms as acute paraproctitis. The main difference between chronic paraproctitis and acute paraproctitis is the lower intensity of the manifestations; moreover, the formation of a pararectal fistula, from which pus is constantly released, comes to the fore.

The skin on which the fistula opens is itchy and hyperemic with signs of maceration, which occurs as a result of skin irritation by purulent discharge.

With an open fistula, the purulent contents of the abscess flow out, and patients, as a rule, are not bothered by pain or discomfort.

Severe pain syndrome is characteristic of chronic paraproctitis with internal incomplete fistula. A sign that suggests paraproctitis is increased pain during bowel movements.

Chronic paraproctitis is characterized by alternating periods of exacerbation and remission. An exacerbation of the disease occurs against the background of blockage of the food lumen of the fistula.

It is an epithelialized tract that does not heal on its own, but requires surgical intervention and adequate antibiotic therapy.

Diagnosis of paraproctitis

Diagnosis and treatment of paraproctitis is carried out by proctologists or surgeons.

The algorithm for examining a patient with suspected paraproctitis is as follows:

collection of complaints;
collection of anamnesis of illness and life;
examination of the anorectal area and perineum;
palpation of the suspected area of localization of the perirectal abscess;
digital examination of the anus;
laboratory tests: general blood test, microscopy and culture of purulent discharge with determination of sensitivity to antibacterial drugs;
probing the fistula;
ultrasound examination of the perineum and pelvic organs through the rectum;
fistulography;
CT scan;
anoscopy;
rectomanoscopy and others.

To make a diagnosis of paraproctitis, an experienced specialist will only need to collect complaints and anamnesis. But in complex diagnostic cases, even experienced proctologists or surgeons have to resort to additional methods diagnostics

When collecting complaints, the doctor pays attention to the combination of intoxication syndrome with local symptoms. It is also important to identify the provoking factors of paraproctitis in the patient, such as hemorrhoids.

IN general analysis blood, there will be signs of inflammation, such as an increase in the erythrocyte sedimentation rate, an increase in the level of leukocytes, including basophils.

With microscopy and culture of secretions from a perirectal abscess, it is possible to verify the pathogen and select the most suitable one based on sensitivity antibacterial drug.

Regarding additional instrumental methods diagnostics, such as anoscopy, sigmoidoscopy, ultrasound, then in acute paraproctitis they can cause severe pain, so they are recommended to be carried out under general anesthesia.

Differential diagnosis

Often paraproctitis has to be differentiated from other diseases, since at the onset of the disease it does not have specific symptoms.

Differential diagnosis must be carried out with the following pathological conditions:

infected lipoma;
benign and malignant tumors colon;
boil and carbuncle (with subcutaneous paraproctitis).

Complications

Acute paraproctitis is dangerous due to its complications, among which the following should be highlighted:

necrosis of the rectal wall;
melting of the urethra, vagina, prostate and other organs that are close to the rectum with pus;
leakage of feces into the perirectal fatty tissue through the necrotic wall of the rectum;
formation of a retroperitoneal abscess due to an abscess breaking into the retroperitoneal space;
purulent inflammation of the peritoneum (peritonitis).

The above complications of peritonitis threaten to develop into sepsis, when the pathogenic organism enters the bloodstream and can even lead to the death of the patient.

There are also a number pathological conditions that occur against the background of chronic paraproctitis, namely:

deformation of the rectal canal;
scar formation;
incompetence of the anal sphincter;
leakage of feces from the anus outside the act of defecation;
rectal strictures.

Chronic perirectal fistulas are covered from the inside with epithelium, the cells of which, during a long process (5 years or more), can transform into cancer cells. The risk of getting cancer is another reason to seek medical help at the first signs of paraproctitis rather than self-medicate.

Treatment of acute paraproctitis

Acute paraproctitis is a direct indication for surgical treatment. For patients who have been diagnosed with acute paraproctitis, surgical intervention is performed on an emergency basis.

The main task in the treatment of paraproctitis is opening the abscess, excavating its contents and installing a drainage system. The operation is performed under general or epidural anesthesia.

Surgical treatment of paraproctitis eliminates only the purulent focus, but not its cause, so the risk of relapse of the disease cannot be excluded.

To minimize the risk of recurrent paraproctitis, the operation is performed in two stages:

the first stage consists of opening the abscess, clearing it of pus and installing drainage;
second phase surgical treatment performed one week after the first operation. During surgery, the surgeon removes the gland or sinus that was affected by purulent inflammation.

Sometimes, if the patient’s condition is satisfactory and the purulent process has not spread to neighboring tissues and organs, the operation can be performed simultaneously. Also, a prerequisite for immediate surgical treatment of paraproctitis is a sufficient amount of information about the localization of the purulent focus.

During the one-stage surgical treatment of paraproctitis, the surgeon finds the source of inflammation, opens the abscess, cleans out its contents, removes the affected crypt or sinus, excises the fistula and installs drainage tubes.

Also during the operation, there may be a need for sphincterotomy, which is a dissection of the circular anal muscles. Such additional manipulation increases the risk of anal incompetence, which can lead to fecal incontinence.

Treatment of chronic paraproctitis

Chronic paraproctitis, like acute paraproctitis, requires surgical intervention, only in this case the operation is carried out as planned and consists of radical removal of the affected tissues and fistulas.

Surgical treatment is also complemented conservative therapy, which increases the body's resistance and accelerates healing postoperative wound, affects the cause and pathogenesis of paraproctitis.

There are several types of operations that are used in the fight against chronic paraproctitis, each of them has its own indications and contraindications, as well as advantages and disadvantages. Let's look at them.

Complete excision of the fistula. This technique gives the highest efficiency rate of 90%. But, unfortunately, complications often arise with this operation, the postoperative wound takes a long time to heal, and there is also a risk of incompetence of the anal muscles.
Gluing the walls of the fistula with fibrin glue. The procedure is carried out after cleaning the fistula tract. This type The operation is considered not only low-traumatic and minimally invasive, but also does not require general anesthesia. Disadvantage this method is low efficiency, which is about 50%.
Insertion of an occlusive tampon into the fistula tract. Materials of animal origin, for example, pig intestines, are used as tampons. After such manipulation, the fistula tract is delayed. The effectiveness indicator of this method is initial stages chronic paraproctitis, when there are no complications, is close to 100%.
Excision of the fistula with installation of a special patch at the resection site, which is taken from the intestinal flap. The indication for this type of operation is a wide fistula tract. The effectiveness rate is quite high and amounts to 60-90%, but there is a risk of complications in the form of anal sphincter failure.
Fistula excision and ligation. During this operation, the outer part of the fistula tract is excised, and a ligature is applied to the rest of the fistula, which is localized in the intersphincteric space. Also during this operation, another ligature is installed for the purpose of drainage, which is removed after 6-8 weeks. This operation also has a high success rate, which ranges from 60-90%.
Excision of the fistula with restoration of the sphincter. In this case, removal of the fistula requires dissection of the anal sphincter in the part where it is damaged. At the end of the operation, the anal muscles are sutured. Despite the high efficiency rate of this method (about 80%), there is high risk violations of the obturator function of the anal sphincter.

The selection of the optimal surgical technique for the treatment of chronic paraproctitis is carried out by the attending proctologist.

Conservative therapy of paraproctitis

As mentioned earlier, treatment of paraproctitis of any form consists not only of surgical intervention, but also of conservative therapeutic methods.

Antibiotic therapy

Antibiotic therapy is a mandatory component of the treatment of paraproctitis. Antibiotics can be used both systemically and locally.

In acute paraproctitis, antibacterial drugs are prescribed after surgery. In case of chronic paraproctitis, antibiotics can be prescribed both during preoperative preparation and postoperative period.

The drugs of choice for paraproctitis are Cefotaxime, Gentamicin, Metronidazole. Let us consider the features of these antibiotics.

Cefotaxime

Cefotaxime is a representative of the third generation cephalosporins and has a wide spectrum antimicrobial action.

The drug has a detrimental effect on Staphylococcus aureus Streptococcus pyogenes, coli, Klebsiela, Proteus, pseudomonas and others. That is, Cefotaxime is active against bacteria that cause paraproctitis.

Cefotaxime is used to treat infections caused by pathogenic microorganisms sensitive to it, including paraproctitis. The drug is also often prescribed to patients after surgery to prevent infectious complications.

Cefotaxime is intended exclusively for parenteral administration(intravenous, intramuscular) and is available in the form of a powder for solution, which is diluted with water for injection, saline or lidocaine.

Adult patients are prescribed 1 gram of Cefotaxime every 12 hours. IN severe cases the dose of the drug is increased, but the daily amount should not exceed 12 grams. Before administering Cefotaxime, a sensitivity test must be performed.

The most common side effect of Cefotaxime is allergic reaction, which manifests itself as dermatitis, urticarial rash, hyperthermia, anaphylactic shock.

In isolated cases, patients experienced nausea, vomiting, abdominal pain, stool upset, dysbacteriosis, and very rarely, pseudomembranous colitis. It is also possible to reduce the number of neutrophils and platelets, hemolysis of red blood cells, heart rhythm disturbances, and headaches.

The drug is contraindicated in persons who have a history of allergies to cephalosporin and antibiotics. penicillin series. In addition, the drug is not used for acute bleeding and a history of enterocolitis.

Since Cefotaxime is excreted by the liver and kidneys, it is prescribed with caution when the functions of these organs are impaired. In pregnant and breastfeeding women, the drug is used when the effect of treatment is higher than the risk of adverse reactions.

Gentamicin

Gentamicin belongs to the aminoglycoside group of antibiotics. The drug has wide range antimicrobial action, adversely affecting most pathogenic microorganisms. The drug is highly effective in combating infections caused by Pseudomonas aeruginosa.

Gentamicin is widely used for inflammatory diseases of the urinary system (cystitis, urethritis, pyelonephritis), inflammation and abscess of the lungs, pleurisy and pleural empyema, purulent processes of the skin, as well as peritonitis, sepsis and other diseases caused by bacteria that are sensitive to this drug.

For paraproctitis, Gentamicin is the drug of choice if the disease is caused by aerobes.

Gentamicin is available as an ointment, eye drops, powder for preparation parenteral solution and 4% ready solution.

For paraproctitis, the drug is administered intramuscularly or intravenously. A single dose of Gentamicin is 0.4 mg/kg body weight. The drug is administered 2-3 times a day. In severe cases, the dose may be increased to 1 mg/kg. The course of treatment is from 7 to 10 days.

Side effects to the use of Gentamicin in patients are rarely observed and may manifest as allergies, hearing loss and impaired renal function.

Gentamicin is prescribed for pregnant women and newborns according to strict indications.

Local antibacterial agents

Systemic antibiotics are not used in all patients, unlike local antibacterial drugs, which are effectively used for all forms of paraproctitis, both before and after surgery. Antibiotics can be used in the form of ointments, powders and creams.

Local use of antibacterial drugs can accelerate the healing of postoperative wounds, prevent infectious complications and increase local tissue resistance.

Most often, the following local antibacterial drugs are prescribed for paraproctitis.

Levomekol is an ointment with a combined composition, which contains the antibiotic chloramphenicol and the regeneration stimulator methyluracil. The drug quickly and effectively relieves inflammation, accelerates the recovery of affected tissues and destroys pathogenic microorganisms.
Levosin is an ointment that is similar in composition to the previous drug, but, in addition to chloramphenicol and methyluracil, it also contains an antibacterial drug - sulfadimethoxine and a local anesthetic - trimecaine. Levosin relieves pain, inflammation, swelling and itching, accelerates healing and prevents tissue infection.

The above drugs are applied to the wound treated with an antiseptic twice a day - morning and evening. Cover the wound from above with a gauze cloth.

Physiotherapeutic treatment of paraproctitis

Physiotherapeutic methods are widely used both for acute paraproctitis in the postoperative period and for the chronic course of the disease.

In chronic paraproctitis, physiotherapeutic methods are used in preparation for surgical treatment to reduce inflammation, destroy pathogenic microorganisms and increase local resistance.

The most effective methods physiotherapy for paraproctitis are the following:

irradiation ultraviolet rays affected areas;
magnetic therapy;
electrophoresis;
ultra-high frequency irradiation;
irradiation with infrared rays.

Treatment of paraproctitis with traditional methods

Before starting treatment with folk remedies, you need to understand that paraproctitis is a surgical pathology, therefore traditional methods will not be enough to cope with the disease.

Traditional medicines can be used as a complement to basic traditional treatment. In addition, such therapy must be approved by the treating doctor. Folk remedies are used both before and after surgery.

The following non-traditional remedies will help relieve inflammation during paraproctitis:

red rowan juice: take 30 ml orally three times a day before meals. Red rowan has antimicrobial, prophylactic and anti-inflammatory effects;
infusion of red rowan berries: 5 grams of dried rowan berries, pour 200 ml of boiling water, cover with a lid and let steep for 40-50 minutes. Take the infusion 1/3 cup three times a day before meals. To improve the taste, you can add a little sugar;
infusion of sage, yarrow and chamomile. Take 5 grams of each herb, pour in 200 ml of boiling water, cover with a lid and let it brew for 25-30 minutes. Take 100 ml infusion twice a day before meals. This infusion is an effective anti-inflammatory agent;
herbal tea: 80 grams of yarrow, 100 grams of marshmallow roots and plantain leaves, pour 600 ml of boiling water, cover and leave for 12 hours. The finished tea is filtered and drunk ¾ cup three times a day;
calendula tincture: applied to the external mouth of the fistula for disinfection;
baths with mumiyo: 10 tablets of the product are dissolved in hot water. When the solution has cooled to room temperature, it is poured into wide pelvis and sit in it. It is strictly forbidden to carry out hot sitz baths, as this threatens the abscess breaking;
baths with sea salt: pour 4-5 liters into a wide basin hot water and dissolve 30 grams in it sea salt. When the water has cooled to room temperature, they sit in it. The bath is carried out for 20 minutes once a day before bedtime. The procedure can also be carried out with decoctions and infusions of medicinal herbs;
rectal suppositories from raw potatoes: a cylinder the thickness of a little finger and 3-4 cm long is cut out of a potato, lubricated with Vaseline and inserted into anus for the night. Such homemade suppositories perfectly relieve inflammation and reduce pain.

Features of the diet for paraproctitis

A special diet for patients with paraproctitis has not been developed. For this disease, experts recommend eating fractionally – 4-5 times a day in small portions of food.

Patients' diets must include soups, which are best eaten for lunch. Dinner should be light and consist of fermented milk products or vegetables.

It is necessary to exclude from the daily diet fatty varieties fish, meat and poultry, fried and spicy foods, and also limit consumption white bread, baked goods and alcoholic beverages.

It is necessary to prepare dishes using gentle heat treatment, that is, boil, bake or steam. It is also necessary to maintain full water balance, that is, drink at least 1500 ml of clean water per day.

In the postoperative period, you are allowed to eat a few hours after the operation. In the first 48 hours after surgery, meals should be light, steamed or boiled. It is strictly forbidden to consume soda, coffee, spicy and fried foods, sweets, baked goods, chocolate, raw vegetables and fruits.

Two days after the operation, the patient’s diet is expanded.

The diet of a patient with paraproctitis must necessarily contain foods rich in vegetable fiber eg cereals, vegetables, fruits, dried fruits, legumes to prevent constipation.

Also, the menu of a patient with paraproctitis must include dairy products(kefir, fermented baked milk, cottage cheese, yogurt and others). Patients who have undergone sphincter plastic surgery are prescribed a special diet. The essence of such a diet is to prescribe medications and nutrition that prevent constipation.

The drug of choice is (Lactulose), which gently relieves constipation without causing addiction. Among natural laxatives, you can give preference to prunes, dried apricots, fresh kefir, beets, carrot juice or olive oil.

If the diet is ineffective, the patient with constipation is given a cleansing enema.

Prevention of paraproctitis

There are primary and secondary prevention paraproctitis.

Primary prevention of paraproctitis is to strengthen the immune system, vitaminize the body, eliminate risk factors, proper nutrition, a healthy and active lifestyle, weight normalization and timely treatment of diseases that can lead to paraproctitis.

Secondary prevention involves a set of measures that will prevent relapse of the disease after surgical treatment. For this use:

Disease prognosis

If you seek medical help in a timely manner, the prognosis for paraproctitis is favorable.

But patients who turned to a proctologist late with acute paraproctitis or engaged in inadequate self-medication are at risk not only of the disease becoming chronic, but also of a number of complications that can even lead to death.

Chronic paraproctitis, if left untreated, leads to the formation of fistulas, which can degenerate into a malignant tumor.

As a result, we can say that paraproctitis in most cases is a complication of diseases of the anorectal region and, most often, hemorrhoids. Therefore, timely and correct treatment of hemorrhoids will also prevent paraproctitis.

If you have ever encountered paraproctitis, share with us how the disease manifested itself, what caused it and how you treated it.