Paraproctitis is an inflammation of the fatty tissue surrounding the rectum (pararectal tissue).
Content
What is paraproctitis?
The cause of inflammation is infections, most often such as Escherichia coli (Escherichia coli), Proteus, streptococci, staphylococci.
In the immediate environment of the rectum, three fascial-cellular spaces are distinguished: subcutaneous, ischiorectal and pelvic-rectal.
Depending on which of the spaces is affected by inflammation, paraproctitis can be of three types:
- subcutaneous paraproctitis,
- ischiorectal paraproctitis,
- pelvic-rectal paraproctitis.
According to the nature of the course, acute and chronic paraproctitis are distinguished.
Acute paraproctitis
Acute paraproctitis is a purulent inflammation of the tissue surrounding the rectum.
The infection penetrates the tissue from the rectum. This can occur when its mucous membrane is damaged and a defect forms in it, through which the infection easily penetrates into the tissues surrounding the rectum.
Injuries to the rectum are usually the result of mechanical force. This may be a small, literally pinpoint, tear of the mucous membrane caused by
- injury,
- small rupture of the internal hemorrhoid,
- anal fissure,
- accidentally swallowed fish bone,
- a sharp fruit pit,
- poorly chewed and overcooked peels from fruits and vegetables.
The cause of paraproctitis is persistent constipation, which is accompanied by hard “sheep” feces. Its passage through the rectum can injure the mucous membrane.
Frequent loose stools with undigested food debris irritate the rectal mucosa and can also lead to microtrauma.
If the infection penetrates the anal glands and a blockage occurs, then in this case acute purulent paraproctitis develops.
Paraproctitis: symptoms
All types of acute paraproctitis are characterized by common symptoms:
- sharp throbbing pains,
- high body temperature,
- chills,
- a significant shift to the left in the blood test: ESR increases, leukocytosis appears.
Each type of paraproctitis has its own characteristic symptoms.
Subcutaneous paraproctitis
A purulent abscess forms in the subcutaneous fatty tissue. If the abscess is located closer to the anus, then compaction and pain appear near the anus. When light pressure is applied to the abscess, it moves.
With a deeper location, there is no redness or thickening.
Body temperature rises to 37.5-38 ºС. When an abscess is formed, the temperature may be higher.
Ishiorectal paraproctitis
With this type of proctitis, a dull pain appears, the body temperature rises to 38 ºС, and a general feeling of malaise is felt.
Redness of the skin is usually absent. A digital examination of the rectum reveals a compaction that bulges into the lumen of the rectum. The examination causes sharp pain.
Pelvic-rectal paraproctitis
This form of paraproctitis is the most severe.
The abscess is located high, under the pelvic peritoneum. Its symptoms are similar to another type of paraproctitis - retrorectal paraproctitis. In this case, the abscess is located behind the rectum.
The condition of patients in these cases is severe, general intoxication of the body is observed, body temperature rises to 40 ºС. However, local signs (changes in the anus) are very mild.
Such forms of paraproctitis are often not immediately recognized and are mistaken for pneumonia or some kind of infectious disease.
Diagnostics
The main research method is digital examination of the rectum .
In the presence of an abscess located high in the pelvic-rectal tissue, there may be no protrusion into the intestinal lumen, but upon digital examination, acute pain is sure to occur, radiating to the pelvis.
To determine the position of the internal fistula, methylene blue is injected into the abscess cavity. When a sterile probe-tampon (tumper) is inserted, the position of the fistula is determined by the location of the blue spot.
Paraproctitis can be detected by colonoscopy .
Treatment of acute paraproctitis
If an abscess has formed, urgent surgery is necessary. It involves opening the abscess and draining it.
If the compaction is small and the temperature is not high, then you can try to cure paraproctitis without surgery.
As a treatment, it is necessary to take hot (37-38 ºС) baths with potassium permanganate for 15-20 minutes. After the bath, a suppository is inserted into the rectum.
For the treatment of paraproctitis, a suppository is recommended consisting of belladonna extract 0.015 g, novocaine 0.12 g, xeroform 0.1 g, white streptocide 0.08 g, 4 drops of 0.1% adrenaline solution, cocoa butter 1.5-2 g. A compress of Vishnevsky ointment is applied to the anus. Before insertion, the candle must be generously lubricated with the same ointment.
Due to pain during defecation, bowel movements are incomplete, so it is recommended to do cleansing enemas.
If such treatment does not help, then the infiltrate grows and the body temperature rises. In this case, surgery is necessary.
How to do cleansing enemas is described in the article “ Proctitis ”.
If such treatment does not help, then the infiltrate grows and the body temperature rises. In this case, surgery is necessary.
Forecast
Timely and correct treatment results in complete recovery.
Prevention of paraproctitis
The main preventive measure is the prevention and treatment of constipation and diarrhea. Attentive attention to the digestive process, eating slowly, and thoroughly chewing food also reduce the likelihood of developing paraproctitis.
Chronic paraproctitis
Chronic paraproctitis (rectal fistula) is a pararectal fistula left after a spontaneously opened abscess or after surgical opening of acute paraproctitis.
After opening an abscess in acute paraproctitis, the internal opening in the rectum, as a rule, does not disappear and forms a rectal fistula. It usually opens into the perineum near the anus.
The disease can only stop if the internal opening in the rectum is eliminated during surgery.
Fistulas are divided into
- full , opening at one end on the mucous membrane of the rectum, and at the other end on the skin,
- incomplete , opening only on the intestinal mucosa.
Symptoms of chronic paraproctitis
A sign of an anal fistula is the presence of one or more external openings, from which thick pus and, less commonly, feces and gases are released.
When such a fistula persists for a long time, the skin swells and irritation appears around the anus.
While the external opening of the fistula is open, exacerbations of paraproctitis practically do not develop. If the internal opening of the fistula is closed by a scar, then the discharge stops and an apparent recovery occurs. But at the slightest damage to this scar, acute paraproctitis occurs again.
Types of fistulas
There are four types of fistulas depending on the location of the fistula tract in relation to the sphincter.
- Subcutaneous-submucosal fistulas (intrasphincteric ). The fistulous tract is located directly under the mucous membrane or in the subcutaneous tissue, inside the sphincter.
- Transsphincteric fistulas . The fistulous tract is directed from the intestine to the outside, directly through the sphincter.
- Complex or extrasphincteric fistulas . The fistula canal from the rectum goes around the sphincter from the outside. The internal opening is usually located at the upper pole of the sphincter. Complex fistulas are often horseshoe-shaped, have two fistula tracts that open in the skin with two holes on either side of the anus.
- Incomplete fistulas . This type of fistula does not have an external opening on the perineum. The fistula tract ends in the submucosa or in the sphincter, sometimes in the tissue behind the rectum.
It is difficult to detect incomplete fistulas. The only sign indicating the presence of such a fistula is small purulent discharge from the anus, and sometimes only itching in this area.
The examination of such a fistula should be carried out by a surgeon. Probing is carried out to determine the internal opening. In very difficult cases, an X-ray examination is performed - fistulography.
Treatment of paraproctitis
Treatment without surgery consists of thermal procedures, sitz baths, and compresses. UHF therapy shows good results. It is necessary to wash the fistulas with solutions of antibiotics, hydrogen peroxide, etc.
Surgery can be difficult. The result is achieved by complete excision of the fistula tract and elimination of its internal opening.
Forecast
In case of surgical treatment and elimination of the fistula, recovery is possible.
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