Paraproctitis: symptoms

According to the clinical course, the paraproctitis is divided into acute and chronic.

Acute paraproctitis is a suppurative inflammation (abscess) of the peritopulmonary tissue.

[1], [2], [3], [4], [5]

Symptoms of acute paraproctitis

The disease has a short (not more than 3 days) prodromal period, during which there may be weakness, headache, general malaise. Then there are typical symptoms of paraproctitis: chills, fever, pain in the perineal region. The degree of severity of clinical symptoms is determined by the reactivity of the organism, the type of bacteria that caused the inflammatory process, and also which of the fascial cell spaces is affected. In the defeat of the cellular spaces of the small pelvis as phlegmon, the general symptoms due to intoxication prevail in the clinical picture. As the process separates and forms an abscess, the intensity of pain increases, it becomes pulsating. Depending on the intensity of the inflammatory process, this period lasts from 2 to 10 days. Then, if there is no surgical treatment, the inflammation spreads to the neighboring cellular spaces of the pelvis, the abscess drains into the rectum or the skin of the perineum. After the opening of the abscess 3 outcomes are possible:

1. recovery;
2. formation of the fistula of the rectum (chronic paraproctitis);
3. the development of recurrent paraproctitis with more or less frequent exacerbations of the inflammatory process.

Chronic paraproctitis is the result of acute inflammation. This is a pararectal fistula formed after spontaneous dissection of an abscess or opening it by a surgical method. Internal, the opening of the fistula is a defect in the rectum. The external opening is located on the skin of the perineum. In a number of cases, it is possible to observe several fistulous passages and several external fistula orifices.

Symptoms of chronic paraproctitis

Symptoms of paraproctitis of this form are a consequence of the acute. In those cases when the opening of the abscess does not eliminate the internal opening in the rectum, a fistula of the rectum can subsequently form (chronic paraproctitis). For the fistula of the rectum is characterized by the presence of one or more external holes on the skin of the perineum near the anus. Out of the outer holes of the fistulous passage, pus, sometimes feces and gases can be released.

The general condition of patients with chronic paraproctitis "suffers" a little. Pain is not the main symptom of the disease. It appears only when the process is aggravated. The nature and amount of discharge from the fistula depends on the activity of the inflammatory process. It should be noted that while the fistula functions (its outer opening is open), relapses of acute paraproctitis are rare. At the same time, there is a special form of the so-called acutely recurrent paraproctitis. With it, a dotted inner opening in the rectum may temporarily be closed with a soft scar, and the fistula ceases to function. If the scar is damaged, the paraproctitis recurs.

Depending on the location of the fistulous movement in relation to the sphincter muscle, there are 4 types of fistula:

• subcutaneous-submucosal, or intrasfinctory, - the fistulous course is located under the mucous membrane or in the subcutaneous tissue inside the sphincter muscle;
• stressfinctorial - the fistulous course is sent from the intestine to the outside through the thickness of the sphincter;
• complicated, or extrasfinctorial, - the fistulous course bends the sphincter from the outside. With this form of fistula, the inner orifice is usually located at the upper pole of the sphincter. Complex fistulas can be horseshoe-shaped. In these cases, the internal fistula opening located on the back wall of the rectum gives rise to two fistulous passages that open on the skin with two apertures on either side of the anus;
• incomplete fistulas have only an internal opening in the rectum and do not have an external opening on the perineum. The source of their formation is often an anal fissure.