Acute Paraproctitis: Treatment, Causes, Diagnosis

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Acute paraproctitis

The content of the article:

1. Causes and risk factors
2. Forms of the disease
3. Disease stages
4. Symptoms
5. Diagnostics
6. Treatment of acute paraproctitis
7. Possible complications and consequences
8. Forecast
9. Prevention
10. Video

Paraproctitis is a purulent inflammation of the fatty tissue surrounding the rectum (perianal, or pararectal, or peri-rectal tissue). Acute paraproctitis is called when it appears for the first time and develops acutely, within three to five days, that is, it is characterized by an acute purulent inflammatory process (acute purulent paraproctitis).

In acute paraproctomy, a focus of purulent inflammation develops in the peri-rectal region

In the structure of proctological morbidity, paraproctitis ranks fourth in frequency. Men are more susceptible to it than women.

The main problem of this disease is that patients, embarrassed, in every possible way postpone the visit to the doctor, which is associated with a high probability of complications, including severe ones.

Causes and risk factors

The main cause of inflammation of the perianal tissue is microtrauma, which opens the gate of infection. In most cases, trauma is caused by hard stool masses, which form during chronic constipation. From the mucous membrane of the rectum, inflammation along the channels of the anal glands spreads to the pararectal tissues. Other less common causes of acute paraproctitis include:

• proctitis;
• anal fissure;
• hemorrhoids.

Any trauma to the anus can also trigger the disease.

There is also a descending path of infection, when inflammation of the perianal tissue develops as a result of an infection with the blood flow from higher sites, for example, in viral diseases of the respiratory tract. This pathway is found mainly in immunocompromised people.

Risk factors include:

• stool disorders;
• poor hygiene;
• hypothermia (both local and general);
• uncomfortable, tight underwear;
• diabetes;
• atherosclerosis;
• alcoholism;
• any other conditions that contribute to a decrease in immune defense.

Forms of the disease

Depending on which of the spaces of the fatty tissue surrounding the rectum (epicutaneous, pelviorectal, ishiorectal, retrorectal), purulent inflammation develops, the forms of acute paraproctitis are determined:

• submucosal;
• subcutaneous;
• subcutaneous submucosal (most common);
• intermuscular;
• pelviorectal, or pelvic rectal;
• ischiorectal, or sciatic-rectal;
• retrorectal (the rarest).

The rectal mucosa forms folds called crypts. When infected, an abscess develops in the crypt, or an abscess - a site of purulent fusion of tissues. Depending on the location of the crypt, abscesses are posterior, anterior and lateral. By the depth of the lesion - internal and external. There can be more than one of them, and of different forms, for example, one is submucous, and the other is pelviorectal.

Paraproctitis can be caused by various pathogens. Depending on their group affiliation, aerobic and anaerobic forms of the disease are distinguished.

Disease stages

Acute paraproctitis, like any acute inflammatory process, has three stages: onset, peak and resolution.

Stage	Characteristic
Onset of the disease	Discomfort in the rectal area, soreness during bowel movements, increased symptoms
High	Severe clinical picture with acute pain and significant deterioration in well-being
Resolution	Relief of pain, stabilization of general well-being

In favorable conditions, when the patient seeks a doctor and receives treatment, at the stage of resolution, recovery occurs, and the disease ends. In unfavorable cases, namely in the absence of treatment, the third stage ends with the development of one of the complications, and the resolution in this case is usually spontaneous opening of the abscess with the formation of a rectal fistula and the transition of the disease into a chronic form.

Symptoms

The following symptoms may indicate acute paraproctitis:

• intense pain in the anus, sometimes a person cannot sit because of it;
• a palpable seal in the anus;
• violations of urination and defecation;
• fever, general malaise.

Different forms of the disease have features in their manifestations. The higher and deeper the abscess is located, the more pronounced the general symptoms and less local ones. So, the most typical clinical picture of subcutaneous paraproctitis: edema and redness of the skin in the perineum and near the anus, severe pain, aggravated by palpation, movements, coughing. When pressing on the inflamed area, a fluctuation symptom is determined, caused by a fluctuation of purulent contents.

With pelviorectal and ischiorectal forms, general symptoms come to the fore: malaise against the background of fever, upset stool and urination, as well as increasing dull pain in the pelvic region and in the lower abdomen.

A sign of a formed fistula is a rapid spontaneous improvement in well-being with abundant discharge of pus from the anus, and in women, sometimes from the vagina, if the fistula has broken through the vaginal wall.

Diagnostics

The main methods are collection of anamnesis and complaints, external examination and digital rectal examination. With a difficult diagnosis, auxiliary methods are used:

1. Ultrasound from the perineum and endorectal - allows you to determine the localization of the abscess, its size, involvement in inflammation of adjacent tissues, the presence of fistulous passages.
2. Bacteriological examination - consists in microbiological examination of a sample of pus, which is obtained by puncture of an abscess. The method allows you to accurately establish the type of pathogen and determine its sensitivity to antibiotics. It is rarely used in acute paraproctitis.

Treatment of acute paraproctitis

Self-medication is categorically unacceptable.

Without exception, all patients with a confirmed diagnosis require hospitalization. Treatment is surgical, and it should be carried out as soon as possible after diagnosis. It consists in opening the focus, its sanitation and drainage. Depending on whether there is a clear idea of the location of the abscess, to what extent adjacent tissues are involved in the inflammatory process and the general condition of the patient, a decision is made to carry out one or another type of operation.

In case of acute paraproctitis, consult a doctor immediately

The radical option consists in the complete removal of a purulent focus with fistulous passages (if they have formed), the rest involve opening the abscess, draining it, excising the affected crypt and, depending on the indications, sphincterotomy, ligation, etc. In such cases, a radical operation is performed the second stage after the acute inflammation subsides, it consists in excision of the purulent passage at the place of drainage.

Surgical treatment is complemented by antibiotic therapy, broad-spectrum antibacterial drugs are prescribed.

In the postoperative period, dressings are carried out with antiseptic treatment, the application of ointments with anti-inflammatory, antimicrobial and wound healing effects.

Possible complications and consequences

If the abscess is not opened in a timely manner, the pus spreads to the surrounding tissues and melts them. A relatively favorable option in this case will be its independent exit through the formed fistulous course and the chronization of the process, but it should be borne in mind that this in itself entails unfavorable consequences.

In other cases, pus penetrates inside, into the intercellular spaces of the pelvis with the formation of further deep foci, possible destruction of the sphincter, pelvic floor muscles and other nearby structures. People with a weakened immune system may develop sepsis and, as a result, multiple organ failure, and then death.

Forecast

In 98% of cases, surgical treatment of acute paraproctitis in the form of a radical operation leads to a complete recovery. If the surgical treatment consisted in creating an outflow of pus (drainage) from the abscess and did not end with radical intervention, a fistulous tract is formed at the site of the drainage hole and the disease becomes chronic. With an advanced disease and severe intoxication of the patient, the prognosis is cautious.

Prevention

There is no specific prophylaxis for acute paraproctitis. General measures include those that strengthen the immune system and avoid trauma to the perianal area. Recommended:

• carefully adhere to the requirements of hygiene, it is especially important not to neglect these people with reduced immunity;
• monitor the regularity of bowel movements, take timely measures to eliminate violations of its function;
• avoid hypothermia;
• promptly seek medical help for rectal pathologies, without self-medication.

Video

We offer for viewing a video on the topic of the article.

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!