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Paraproctitis
Last reviewed: 17.10.2021
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Paraproctitis is inflammation of the cell (pararectal) surrounding the rectum. Of the total number of proctologic diseases, paraproctitis accounts for 15.1%. Paraproctitis usually develops in anal crypts. Symptoms of paraproctitis are pain and swelling.
Anorectal abscess is a limited accumulation of pus in the pararectal area.
[Causes of the paraproctitis
It is believed that men suffer from paraproctitis more often than women. If we take into account the reports of different authors, this ratio varies from 1.5: 1 to 4.7: 1. Despite the fact that paraproctitis is considered mainly as an adult disease, it is also found in children. In one series of observations, 200 cases of paraproctitis in children from the newborn to 14 years of age have been described.
There are 3 fascial-cell spaces: subcutaneous, ischiorectal and pelvic-rectal. Accordingly, paraproctitis is also subdivided into subcutaneous, submucous, ischio-rectal and pelvic-rectal. Paraproctitis is caused by various microorganisms penetrating into the cells from the rectum through the anal glands, damaged mucous membrane, and also by hematogenous or lymphogenous pathway from neighboring organs affected by the inflammatory process.
Particular importance in the pathogenesis of paraproctitis has direct damage to the mucosa of the rectum in the region of the posterior wall of the anal canal, where wide and deep crypts are located, which are the entrance gates of infection. Each crypt opens up 6 to 8 ducts of anal glands. According to them, the infection spreads to the pararectal cells. In most patients (98%) paraproctitis is non-specific and is caused by staphylococci in combination with E. Coli. Specific infection (tuberculosis, actinomycosis, syphilis) is observed in 1-2% of patients with paraproctitis.
Paraproctitis can be localized in various areas surrounding the rectum and is superficial (subcutaneous) or deep. Perianal abscesses are superficial under the skin. Ischiorectal abscess deeper, spreads from the sphincter to the ischiorectal space below the muscle that lifts the anus; An abscess can spread to the opposite side, forming an abscess in the form of a "horseshoe". The abscess is higher than the muscle that lifts the anus (ie, the axillary abscess, pelvio-rectal abscess), is located deep enough and can reach the peritoneum or abdominal organs; This abscess is often a consequence of diverticulitis or inflammatory pelvic disease. Sometimes anorectal abscess is a manifestation of Crohn's disease (especially of the large intestine). Usually there is a mixed infection, including Escherichia coli, Proteus vulgaris, Bacteroides, streptococci with a predominance of staphylococcus.
Symptoms of the paraproctitis
Superficial abscesses can occur with severe pain syndrome; characterized by swelling in the perianal zone, hyperemia and pain. Deeper abscesses can be less painful, but cause signs of intoxication (eg, fever, chills, malaise). When examined, the local symptoms of paraproctitis are sometimes absent, but with a finger examination of the rectum, the tenderness of the intestinal wall and the fluctuating protrusion of the wall can be detected. High pelviorectal abscesses can cause pain in the lower abdomen and fever without signs from the rectum. Sometimes fever is the only symptom of the disease.
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Treatment of the paraproctitis
Treatment of paraproctitis consists in surgical drainage.
You can not expect a spontaneous breakthrough of the abscess, you need an urgent opening and adequate drainage of the abscess. Surface abscesses can be drained in an outpatient setting; deeper abscesses require drainage under operating conditions. Patients with fever or diabetes should be prescribed antibiotics (eg, ciprofloxacin 500 mg IV every 12 hours and metronidazole 500 mg IV every 8 hours, ampicillin / sulbactam 1.5 g IV every 8 hours); patients with subcutaneous abscesses do not need antibiotics. After drainage, anorectal fistulas can form.