Paraproctitis is an inflammation of the rectum. With this disease begin to appear sharp pain in the anus and perineum, high fever, chills, dysfunction and urination. Locally you can see swelling and redness of the anus, the formation of an infiltrate and an abscess. As complications, the chronic course of paraproctitis, fistula, inflammation of the organs of the urinary system, sepsis. Surgery is always performed.
Paraproctitis is a disease that is characterized by the development of the inflammatory process and suppuration of rectal tissues, due to the entry of bacterial infections from the lumen through the anal glands of the bottom of the blinkers into the deeper layers of the pararectal area. Paraproctitis is acute and chronic. Chronic flow occurs as a result of insufficient or incorrect treatment of acute course.
As a causative agent of paraproctitis, mixed type of intestinal microflora predominates in women and men: the presence of staphylococci and streptococci, Escherichia coli. In some cases, specific reactions to infection, for example, the course of actinomycosis and tuberculosis, are noted.
Symptoms of paraproctitis
What does the symptomatology look like in acute course? Acute paraproctitis will manifest itself as a characteristic purulent inflammation with such symptoms as pain, hyperemia, hyperthermia and edema of tissues. It is also possible suppuration. With this diagnosis, anaerobic microorganisms contribute to the onset of necrotic tissue destruction. Since putrefactive inflammation prevails, the development of putrefactive paraproctitis begins, characterized by large-scale pathological processes in the rectal cavity, a high rate of tissue destruction and pronounced intoxication. Predominantly, acute muscle and fascial structures are affected.
How does the symptomatology look in the chronic course of the disease? Symptomatic of chronic paraproctitis is less pronounced than in acute flow. In the case of a chronic type, there is a pararectal fistula, manifested by purulent or sucric discharge into the perineal region. Because of this, the skin becomes irritated and itching occurs. The fistula, which has a free outlet for pus, will not primarily disturb the patient with painful sensations or discomfort. Pain syndrome will occur if there is an incomplete internal fistula. In this case, pain can be intensified during defecation and subside after it. Clinical symptoms of chronic paraproctitis in pregnancy will appear wavy, with stihanii and exacerbation.
Opened paraproctitis requires surgical intervention. Immediately after this diagnosis of the disease with acute course was established, an operation is carried out to drain the focus of the purulent inflammatory process. Since muscle relaxation and qualitatively carried out anesthesia are important factors, a complete anesthesia in the operating area is required. What does anesthesia look like when treating a disease? To date, surgical intervention is carried out using epidural or sacral anesthesia, and if the abdominal cavity is affected, general anesthesia is given. Local anesthesia is used in case of paraproctitis.
In the process of operation with a closed type of abscess, specialists must first find it. It is mainly located in the small pelvis. In the case of chronic paraproctitis in men and women, a mature fistula is required for complete excision. However, surgical intervention to remove the fistula with active purulent inflammation is impossible. First, the existing abscess is opened, draining thoroughly, only after this is allowed to remove the fistula.
If there are infiltrated areas in case of disease in the canal, then an anti-inflammatory and antibacterial course of treatment is appointed before the operation, which is often combined with the methods of physiotherapeutic procedures.
Fistula removal should be performed as soon as possible, as relapse occurs very quickly. In some cases, the operation can not be carried out. So, the patient's age category, weakened immunity, severe course of decompensated diseases can affect the temporary refusal of treatment of the disease. However, in this case, conservative techniques are envisaged for the treatment of pathology in paraproctitis, which allow improving the patient's condition, and only after that to perform a surgical intervention.
In some cases, when there is a prolonged remission of the disease, the fistulas can close, in which case the surgical intervention will be postponed, since it is very problematic to clearly define the channel to be excised. The surgical intervention becomes expedient with a well-visualized reference point - that is, when the paraproctitis is opened.
If the surgical treatment of the disease is carried out in time, you can achieve full recovery. If there is no treatment and there is insufficient drainage, the source of infection is not removed, then the synchronization of the disease and the formation of the fistulous course begin. If the fistulas are not removed in time, they begin spreading to deeper departments, and later it will be problematic to remove the infection that will cause permanent relapse. Because of the prolonged purulent process, there may be cicatricial changes on the surface of the walls of the anal canal of the sphincter, as well as the appearance of adhesive processes in the cavity of the small pelvis.
The first task of paraproctitis diagnosis is based on patient complaints, clinical picture and visual examination, identifying and locating the abscess on the surface that surrounds the rectal cavity.
It is simple enough to diagnose a subcutaneous type of disease. The abscess, which is localized in the area of subcutaneous tissue in the perianal zone, will manifest itself quickly and brightly. Thus, it is possible to make a diagnosis of paraproctitis, based on the clinic, external examination, palpation. It is worth noting that various instrumental studies to identify acute type of disease are not carried out, as they bring severe pain to the patient.
Ischiorectal paraproctitis gives changes in the form of smoothing of perianal folds and pronounced gluteal asymmetry. Therefore, pay attention to the constant pain in the anus, with no visible changes. A characteristic feature is the presence of an infiltrate in the channel of the anal cavity. If the diagnosis is clear, then an instrumental examination is not carried out.
Submucoparous paraproctitis will be diagnosed by finger examination of the rectal cavity. Predominantly with this form in the cavity there is a pronounced swollen abscess that spreads to the subcutaneous tissue when the mucosa of the lower ampulla of the rectum is peeled off.
Pelviorectal type of the disease will be difficult and often diagnosed late. This is due to the fact that the inflammatory processes are localized deep into the pelvis. A finger examination is performed, in which the morbidity of the walls of the upper ampular section is noted. Also used ultrasonography. The main diagnostic procedures are assessment of the clinic and finger examination.
Chronic paraproctitis in pregnancy will be diagnosed due to data from finger examination, visual examination and study of the clinic. In some cases, with an unclear diagnosis, it is possible to conduct instrumental examinations. In chronic paraproctitis, the pain of the walls, the redness of the skin near the anal opening and the rectal mucosa are noted in men and women. In fecal masses, a high content of pus and blood impurities is found.
Paraproctitis for ICD 10
To date, there are a large number of different paraproctitis classifications in women and men. In accordance with the international classification of diseases, paraproctitis refers to the ICD-10 code K61.0.If you do not list all the groups of the ICD 10, then it is worthwhile to cite below such a classification, which is the most rational from the point of view of the medical community:
- In accordance with the etiological signs of paraproctitis can be divided into banal, specific and post-traumatic. Here you can also include ordinary, anaerobic and traumatic diseases.
- In accordance with the activity of the inflammatory process, paraproctitis can be divided into acute, infiltrative and chronic.
- In accordance with the anatomical principle, the paraproctitis can be divided into complete, external, incomplete and internal.
- In accordance with the location of the internal fistula, the paraproctitis can be divided into the anterior, posterior and lateral.
- In accordance with the fistula, the paraproctitis can be divided into intrasfinctory, transsfinctorial and extrasfinctorial.
- According to the course of pathological processes paraproctitis can be divided into superficial and deep.
Where paraproctitis will be localized depends on what anatomy of surrounding muscles, cell space and fasciaes near the rectum. There are different cellular spaces, such as subcutaneous, ischiorectal and pelvio-rectal. Inflammatory processes can begin in the submucosal tissue directly in the place where the infection has got.
The most simple and universal is such a table according to the ICD code 10 paraproctitis, as:
- Subcutaneous - it is also paraanal.
- Sciatic-rectal - it is also ischiorectal.
- Pelvic or rectal or subperitoneal - pelviorektralny or subperitoneal.
Some medical representatives are specialized species - horseshoe, Y-shaped, shingles phlegmon and others. However, the medical community sees no point in isolating such forms of the disease into a separate classification, since they represent a variety of basic types of paraproctitis. The most common is subcutaneous paraproctitis. If you perform a comparative analysis, the incidence of these types can be characterized by such figures in the mean value:
- Subcutaneous - 56%.
- Ischiorectal - 34%.
- Subperitoneal - 8%.
- Submucosa - 2%.
As you can see, the classification of paraproctitis in the ICD 10 is very diverse, and for each of the subspecies can be attributed to various types of disease.