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Paraproctitis: diagnosis
Last reviewed: 23.04.2024
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Diagnosis of acute paraproctitis
The greatest importance in the recognition of acute paraproctitis is examination of the anal zone and digital examination of the rectum.
On examination, attention is drawn to the hyperemia of the skin in the perineal region on the side of the lesion. With the location of the abscess in the immediate vicinity of the anus, the anus deforms. Palpation of the perineum is painful. Fluctuation can be determined. Finger examination of the rectum is also painful in many cases, and should be performed with caution. This technique can not be neglected, since the information obtained with it can be very valuable for the recognition of almost all forms of acute paraproctitis. With subcutaneous paraproctitis, which accounts for approximately 50% of all cases of acute paraproctitis, finger examination makes it possible to determine the infiltrate, including its upper border. With submucosal paraproctitis, which occurs in 1.9-6.3% of patients with acute paraproctitis and belongs to mild forms of the disease, finger examination can reveal a round, stiff submucosal formation protruding into the lumen of the rectum over the crest line. Ischiorectal paraproctitis occurs more often (35-40% of the total number of patients with acute paraproctitis). The paraproctitis of this localization is also characterized by infiltration of the wall of the lower ampullar part of the rectum and the anal canal above the crest line. Infiltration can not be determined only in cases where pus quickly spreads to the subcutaneous tissue and breaks through to the skin of the perineum. With the rarely encountered severe form of acute paraproctitis - pelvic rectal (pelvio-rectal) - finger examination reveals the initial signs of this lesion: painfulness upon palpation of one of the walls of the middle or upper ampullar rectus, its dough consistency or dense infiltrate. The upper pole of the pelviorectal infiltrate is usually not detected with the finger. Rectoromanoscopy reveals flushing and velvety of the mucous membrane in the area adjacent to the infiltrate. When the infiltrate swells into the lumen of the intestine, the mucous membrane over it is devoid of folding, and at the time of the rectoromanoscopy it diffusively bleeds (contact bleeding).
[Diagnosis of chronic paraproctitis
When the patient is questioned, the duration of the disease, the frequency of exacerbations, and the methods of treatment used are specified.
During the examination, attention is paid to the condition of the skin of the perineum. Palpation of the perianal area and perineum allows to determine the presence of scar process and the degree of its development.
Finger examination of the rectum makes it possible to judge the tone of the sphincter and in some cases to detect the internal hole of the fistula.
Be sure to probe with a metal trigger probe, which is injected into the fistulous passage through its outer opening. Using the probe determine the direction of the fistulous course, its relation to the sphincter muscle.
A sample with a coloring substance serves to determine the patency of the fistulous course, the location of the internal opening and the purulent cavities in the cellulose.
Fistulography is an obligatory roentgenologic examination of fistula of the rectum, especially important for the detection of trans- and extra-friccnar fistulas.
Rectoromanoscopy is performed to detect concomitant inflammatory diseases, tumors and high internal fistula.