Necrotic paraproctitis: how to recognize and correct in time necrotic abscess - an infectious disease in which the inflammatory process affects the rectum, perineum, and surrounding tissues - tendons, muscles, fascia and subcutaneous fat. Infection in the near-rectal region is fraught with serious complications, which is due to its propensity to generalize and further disruption of the function of other organs and systems.


Pathogens

infection As with other inflammatory diseases of the localization of abscess can cause a variety of microbial agents association:. Staphylo-, streptococci, pneumococci, Proteus, Klebsiella and others

Factors that increase the likelihood of disease include weakened immunity, a sharp weight lossBody, bad habits and a number of diseases leading to a decrease in the reactivity of the body.

Ways of distribution. The rectum, like other parts of the gastrointestinal tract, contains in the thickness of the mucous membrane of the gland. The secret of such glands is mucus, which facilitates passage of fecal masses along the final part of the large intestine. Frequent constipation, hemorrhoids, anal fissures can lead to disruption of their function with subsequent blockage. Fecal masses are delayed, defecation is hampered, which leads to an increase in the number of pathogenic microbes concentrated in the inflammation zone. The contact path is also realized in operations and medical manipulations as a result of non-compliance with hygiene rules.

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The hematogenous pathway occurs with inflammation in the rectum affecting the vessels. These include thrombosis of hemorrhoids. Among distant sources of infection, carious teeth and tonsillitis can be identified, which, however, is quite rare.

Types of necrotic paraproctitis

In the clinical classification of necrotic paraproctitis, the following forms can be distinguished:

  • Putrefactive;
  • Anaerobic clostridial;
  • Anaerobic nonclostridial;

The putrefactive form of necrotic paraproctitis is rightfully considered one of the most difficult. The impact of Bacteroides, Escherichia, Proteus, and fuzobakterii peptokokki on the background of hypothermia, severe diabetes, vascular disease most often results in this type of disease.

Inflammation is rapidly spreading beyond paraproctium, covering the lumbar region, the abdominal wall, scrotum and penis. Necrosis of the skin and adjacent tissues is accompanied by an unpleasant odor, a secretion of a liquid reminiscent of "marsh" gases. Intoxication leads to an increase in body temperature, malaise, loss of efficiency.

Paraproctitis anaerobic clostridial

Just like the previous form, developed with advanced forms of diabetes, diseases of the arteries and veins. Pathogens are different species of clostridia. The first symptoms of infection appear only 3-48 hours after infection. The clinic of necrotic paraproctitis is similar to a lot of inflammatory processes of other localizations, i.e. Nonspecific. An acute onset against a background of complete well-being, a sharp increase in the pulse rate, a drop in blood pressure, a change in the color of the skin from pale pink to grayish or cyanotic. Sharp, sometimes intolerable pain in the area of ​​injury, due to circulatory disorders and nutrition of tissues. The pathological process in the cellulose is caused by the action of toxin released by clostridia. Rotting is one of the most dangerous consequences of hemolysis and blood flow in the vessels. In addition, tissues can be prone to swelling, the formation of gases and the early disintegration. Edema and gas formation, in turn, increase the pressure in the tissues, then the compression of the veins and arteries occurs. Here, and includes a "vicious circle", aggravating the inflammatory process.

On examination the patient should pay attention not only to his complaints, but also physical examination, paying special attention to local changes( statuslocalis).The coloration of the perineal skin changes over time, depending on the stage of the pathological process. The shade of it varies from brilliantly white at first to black and gray when the decay process is over.

Palpation of tissues reveals a characteristic "crepitation" - crackling of air bubbles. The same gas bubbles can be seen at the opening of the affected area along with the yellowish-brown liquid with putrefactive odor. Necrotic changes affect the muscles, fascia, tendons. With far-reaching processes, infection can spread to the periosteum.

If suspicion of anaerobic infection is worth expressing special alertness, because the treatment with this form is different from the therapy in aerobic paraproctitis.

It can be differentiated on the basis of a clinic: absence of pus, redness of superficial tissues, characteristic brownish skin tone, intolerable pain, crepitation of tissues. In addition, an anaerobic paraproctitis will be distinguished by an x-ray and bacteriological examination of the biopsy specimen. On the x-ray, "pinnatus" is revealed. Microscopy of the smear when staining methylene blue allows you to identify the characteristic sticks, reminiscent of the form of matches, as well as gas bubbles and the absence of leukocytes.

Anaerobic necrotic paraproctitis may also be non-clostridial, caused by bacteroides and fusobacteria. Weakened by long-term antibiotics, reducing oxidative processes, the body is more likely than others to develop it.

The clinic and diagnosis largely coincide with the previous form, which requires special attention in the bacteriological study of the material.

General principles of diagnosis

Diagnosis of any form of paraproctitis can be carried out by examining the anorectal area and finger research of the rectum.

The most characteristic symptoms: anus deformation, painful palpation of the affected area, a symptom of fluctuations, bleeding, disappearance of the folds of the rectal mucosa.

Among the instrumental methods are most effective: sigmoidoscopy, fistulography, sounding with a probe probe, by which the presence of fistula and its location is determined.

What is the danger of paraproctitis?

With any form of the disease, complications are possible, they must be combated even before the first signs appear. These include: the spread of the process to the walls of the rectum and bladder, pelvic peritonitis, opening of the abscess on the skin, inflammation of the pelvic fat. There are recurrences of the disease, scar changes, constriction and deformation of the anus.

How to treat?

One of the most important principles of treatment is the promptness and timeliness of therapy.

Surgical intervention is the only effective method for all forms of paraproctitis. The essence of the operation is to drain the site of inflammation after opening and removing non-viable tissues. For the purpose of fixing the result, an overlapping of the course is carried out, along which the spread of inflammation is possible.

Only after the necrosis site is opened and cleared, conservative therapy is prescribed: antibiotics and physiotherapy procedures. Anaerobic forms are treated by using oxygen pressure chambers.