Inflammation of the fiber surrounding the lower section of the rectum, with the formation of ulcers, usually affects the adult population aged 20 to 50 years and mostly men. However, child paraproctitis is also often a phenomenon. In children, paraproctitis is most often observed among newborns and infants.
In children, as in adults, the development of the inflammatory process is associated with the penetration of pathogenic bacteria into the peritemporal tissue. Beginning in the mouth of the anal gland and intestinal crypt, the infection penetrates into the pararectal tissue and, depending on the depth of penetration, the inflammation is divided into different species. The causes of paraproctitis in children up to a year are mainly staphylococcal infection and diaper rash, irritation of tender baby skin near the anus.
The development of the disease in children is provoked by the following factors:
- microtraumas surrounding the anus of space;
- constipation, untimely exit of stool;
- disorders of the immune system with changes in the formation of intestinal microflora;
- congenital pathology of the rectal mucosa;
- non-observance of sanitary rules and hygiene.
Inflammatory process through numerous channels and branching of the duct of the anal glands creates a condition for penetration of pus inside and affects the internal organs of the child.
Symptoms of paraproctitis in children
In children, the disease can occur in acute or chronic form. Symptoms of paraproctitis in infants are:
- swelling of the peri-zone and blood-filled vessels around the anus;
- constipation or diarrhea accompanied by fever;
- accompanying urination and defecation with severe pain;
- lack of appetite, restless behavior.
Paraproctitis in newborns is most often found in the form of subcutaneous abscess and is caused by non-compliance with personal hygiene rules, congenital proctologic pathologies, decreased immunity, chronic infection of the digestive tract. Signs of paraproctitis in a newborn is a sharp decrease in appetite, constant anxiety, the child is capricious. The disease proceeds very rapidly with an increase in temperature to 38-39 ° C, vomiting and an increase in toxicosis. The child becomes drowsy, sleepy.
The subcutaneous form of paraproctitis on the general condition of the newborn affects slightly, with a brief increase in temperature, capriciousness. On the perineum near the anal opening there is swelling, and when palpation a tight knot is felt near the anal opening, giving pain.
The size of the nodule fluctuates, amounting to one centimeter or occupying space up to the posterior adhesion of the labia in girls and to the longitudinal suture on the scrotum in boys. One day after the onset of paraproctitis, softened areas appear in children. The localization of inflammation in the submucosal layer of the lower body of the rectum indicates a submucosal acute inflammation. At the same time, the child is worried about the escape of gases and the release of stool. Rectal examination is painful and reveals at a distance of 1-2 cm from the transitional fold, swelling, edema of the rectum wall. The swelling softens as early as the first day of the disease. Anoscopy shows bleeding and swelling of the mucosa, flushing and edema of the anatomical recesses of the rectum. After some time with the progression of the disease, an incomplete fistula may form. In the future, the infection spreads upwards to affect the pelvic-rectal tissue. With the subcutaneous-submucosal form of paraproctitis, in addition to the common symptoms, pain and delay in urination are added to the babies.
Spontaneous breakthrough of the abscess forms incomplete fistulas in the rectal or rectal-adjacent area. When involved in the inflammation of the cellular tissue of the rectum sciatic space, a fistula is formed, passing through the sphincter. The clinical picture of sciatic-rectal, acute pelvic-rectal paraproctitis in infants is characterized by rapid progress in the formation of deep abscess, which can be considered the onset of sepsis. External signs are practically absent, but palpation of the perineum responds with sharp pain. The child becomes sluggish, the body temperature rises to 40 ° C, there are malfunctions in the heart activity, frequent vomiting with rapidly growing manifestations of toxicosis.
With the most dangerous anaerobic form of paraproctitis in children, which fortunately happens extremely rarely, the general condition of the child deteriorates very sharply, and the rapidly developing inflammatory process leads to large disruption of the rectum and perineum. Often when paraproctitis in children, fistula, characteristic of a chronic disease is the result of not an acute process, but an inborn pathology. Infection, penetrating into this fistula, turns the incomplete fistula into a complete fistula and is an intra-sphincter in relation to the sphincter. The clinical picture of the chronic form of the disease in the period of exacerbation resembles a sharp one, but proceeds much milder.
Treatment of paraproctitis in children
Before choosing a treatment tactic, you need to establish a clear diagnosis that determines the location of the abscess or fistula. Chronic paraproctitis in infants is diagnosed on the basis of external examination and a survey of parents. Finger research makes it possible to detect a fistulous course and when exacerbation of chronic paraproctitis also determine the abscess. Determine the position of the stroke in relation to the sphincter and its location allows fistulography, ultrasound, sounding.
The treatment of paraproctitis in newborns has its own characteristics associated with small child sizes. To determine the main signs of bacterial infection, a general analysis of the child's blood for white blood cell count and erythrocyte sedimentation rate is done. Chronic paraproctitis in infants is treated conservatively, since up to two years, surgical intervention is not recommended. To this end, use anti-inflammatory and disinfecting candles, light antibiotics, ichthyol ointment and Vishnevsky ointment.
For very young children apply bathing in weak disinfectant solutions, in the afternoon and in the evening 2-3 times a day. When the child can sit, make a sedentary bath with a disinfectant solution. Prevention, including careful skin care in the area of the anus, timely removal of secretions and dietary nutrition, helps to avoid exacerbation.
In acute disease, children need urgent surgery. Preoperative preparation is minimized and consists of rinsing the stomach, performing a cleansing enema and subcutaneous administration of a solution of atropine( 1%).The operation is performed under special anesthesia, while mask anesthesia is supplemented with local anesthesia. The scope of surgical intervention is determined based on the nature and localization of the inflammatory process. If children have an exacerbation of chronic paraproctitis of complex shape, then urgent surgery is needed. Moreover, paraproctitis in newborns and infants is not treated with folk remedies.