What is the rectal abscess?Paraprocts - purulent inflammation of the tissues surrounding the rectum.
Allocate acute (first emerged), and chronic abscess (developed as a result of inadvertent or improper opening (treatment) of acute paraproctitis).
Rectal abscesses are common in patients with previous anorectal disease, diabetes, alcoholism and neurological diseases, infections in this area most often develop as in patients with acute leukemia, especially in the presence of neutropenia. Since the clinical picture can for a long period regarded as a fever of unknown origin, it is important that patients with unexplained fever certainly made a careful finger and endoscopic study of the rectum.
Causes of rectal abscess (paraproctitis)The causes of paraproctitis are many:
- Failure to comply with the rules of personal hygiene
- Traumatic manipulation of the anal canal
- The presence of diseases of the anus (hemorrhoids, anal fissures, kriptity, etc.).
A special glands located in the anus, an infection of the lumen of the colon gets into the surrounding tissue. Inflammation develops, forming an abscess. Therefore, a simple opening ulcers outside, without an internal reorganization of the inflamed area, does not lead to a more sustained recovery.
Acute abscess occurs when an infection in the rapid penetration of adrectal (near-rectal) cellular space. Depending on the size of the human immune system and the location of the abscess may be different. Abscess can be located directly under the skin of the perineum (subcutaneous - most often) and deep between the muscles of the perineum and buttocks (ischio-rectal, pelvic rectal, and as one of the types of pelvic-rectal behind rectal).
Chronic abscess usually occurs when a spontaneous dissection or wrong (treatment) of acute paraproctitis.
Acute abscessAcute abscess occurs when an infection in the rapid penetration of adrectal subcutaneous cellular space (most often) ishiorektalnoe, pelviorektalnoe, retrorektalnoe (very rare). Depending on the affected area paraproctitis distinguish localization subcutaneous, etc. Inner hole abscess almost always the same, external ulcers may be two or more. More than half of patients located at the boundary ulcer of the mucosa and skin.
Acute paraproctitis - this is primarily a sharp pain, growing by walking, coughing, etc. Overall condition is deteriorating, especially in the deep (ishiorektalnyh, pelvic, rectal) abscesses, while the outward signs of redness of the skin, fluctuations - virtually no.
With deep (high) ishiorektalnom etc. paraproctitis acute patient's condition may be severe fever, signs of intoxication, pain deep in the pelvis.
Acute paraproctitisThe disease usually begins acutely. Following a short prodromal period with malaise, weakness, headache appears increasing pain in the rectum, perineum or in the pelvis, accompanied by fever and chills. The severity of the symptoms of acute paraproctitis depends on the location of the inflammatory process, its prevalence, the nature of the causative agent, the reactivity of the organism. With the localization of an abscess in the subcutaneous tissue of the clinical manifestations are expressed more clearly and specifically: painful infiltration into the anus, skin flushing, fever forced, as a rule, seek medical attention in the first days after the onset of the disease.
Ishiorektalny abscess in the early days of the common symptoms of the disease manifests itself: chilliness, poor health, a dull pain in the pelvis and rectum, worse defecation, local changes in the asymmetry of the buttocks, infiltration, hyperemia of the skin to appear in the late stage (5-6th day).
The most difficult runs pelvic rectal abscess, where the abscess is located deep in the pelvis. In the early days of the disease is dominated by general symptoms of inflammation: fever, chills, headache, pain in the joints in the pelvis, abdomen. Often the patient goes to a surgeon, a urologist, a woman to a gynecologist. Often they are treated for an acute respiratory illness, influenza. The duration of this period, sometimes as high as 10-12 days. In the future, marked increase in pain in the pelvis and rectum, delay stool, urine and severe intoxication.
Chronic abscessChronic abscess usually occurs when a spontaneous dissection or wrong (treatment) of acute paraproctitis.
The bore of an abscess in the anal canal does not heal and remains a fistula. Healing can occur fragile scar that with a slight injury of cycling, constipation, etc. again there is an abscess, inflammation is not the same place the anal canal, and the localization of the abscess may be elsewhere crotch. After opening and improper treatment of the wound on the perineum does not grow rectal fistula remains, thus there is a re-infection of the intestinal flora through the internal opening of the fistula.
In most patients, the cause of infection can not be identified. Rectal abscesses are usually very painful, are easily detected by palpation, often seen during the inspection. Treatment consists of incision and drainage of conduct.
DiagnosticsThe first and foremost task of the diagnosis of acute paraproctitis based on patient complaints, clinical examination and to recognize the presence and location of the abscess in the cellular spaces surrounding the rectum.
Identify the disease during inspection and digital examination of the rectum.
To prevent complications of acute paraproctitis women also need to consult a gynecologist, and men - a urologist.
Acute paraproctitis surgery alone. The operation must be performed immediately after diagnosis. The operation is performed under general anesthesia.
The goal of surgery is to reveal ulcer (abscess) and removal of pus. After the surgery is performed dressings, prescribed antibiotics, vitamins, and tools that increase immunity. This operation can be carried out in any surgical hospital.
However, opening the abscess is not a radical operation: after it, as a rule, there are recurrent abscesses (chronic abscess is formed). The reason for this phenomenon in the preservation of the inflammatory channel (fistula) between the rectum and surrounding tissues.
For a complete cure requires a second operation, performed in a specialized proctology hospital. As a result of the transaction the relationship between oral cancer and ulcer wound. It's called a radical, as leads to a complete cure.
ComplicationsEvent of failure surgical treatment of acute paraproctitis may develop complications purulent destruction of the wall of the rectum and / or the walls of the urethra in men, the breakthrough of pus in the vagina in women. The most severe complication is the breakthrough of pus in the cavity of the pelvis, that the late diagnosis can lead to death.
After opening the abscess spontaneously or surgically without the elimination of purulent course and struck the crypt in the future, as a rule, formed a rectal fistula. If the fistula is not formed, but it was the inflammation of the anal glands and the space between the sphincter, then after a while there is a relapse of acute paraproctitis.