Acute Paraproctitis

Question 1

What is Acute Paraproctitis?

Answer 1

-purulent inflammation of pararectal tissues

Question 2

Etiology of Acute Paraproctitis

Answer 2

Mixed flora (Staphylococcus, Streptococcus in combination with colon bacillus)
Due to spread of infection from anal crypts into the paraproctium
Trauma of rectal mucous membrane due to different rectal diseases.

Question 3

Pathogenesis of Acute Paraproctitis

Answer 3

Infection gets to anal glands from the lumen of the rectum through cripts (ducts of anal glands)
Inflammatory infiltration leads to obstruction of the duct
Abscess of the gland appears
After glands destruction infection spreads into pararectal cellular tissues.

Question 4

Classification of Acute Paraproctitis

Answer 4

According to Localisation;

• subcutaneous
• ischiorectal
• sub mucosal
• pelviorectal

According to etiological sign

• nonspecific (common)
• specific
• post traumatic

According to inflammatory activity

• acute anal abscess
• relapsing periproctitis
• chronic periproctitis(renal fistula)

According to position of internal fistulous opening

• anterior
• posterior
• lateral

According to position of the sinus tract in relation to the fistulous fibre

• intersphincter
• transsphinter
• extrasphincter

Question 5

Clinical picture of Acute Paraproctitis

Answer 5

• pain in perineum and around the anus which occurs rapidly
• simultaneous increase in body temperature
• incase of ischiorectal and pelviorectalpain can be late onset of symptoms, feeling of pain in the anus proceeds in it
• in the beginning symptoms of general intoxication predominate

Question 6

Diagnosis of Acute Paraproctitis

Answer 6

Sweeping, skin hyperemia around the anus incase of subcutaneous Paraproctitis

• digital rectal examination is done for ischiorectal periproctitis
• Proctosigmoidoscopy for pelviorectal periproctitis
• thermography
• US for acute anal abscess

Question 7

Treatment of Acute Paraproctitis

Answer 7

Surgical
-Done under general anasthesia
If there are no concomitant diseases preoperative preparation is minimal

Radical operation of anal abscess is done for;

• adequate draining of the pyogenic abscess
• removal of internal orrifice through which the pyogenic abscess communicates with the rectal lumen

The first stage of the operation-draining of the pyogenic abscess is performed by two types of incisions

• radial
• semilunar

The second stage of operation-removal of internal orrifice of the pyogenic abscess incase of subcutaneous paraproctitis-Gabriel operation

After radical surgery practically all the patients make convalescence (recovery)
-draining of the pyogenic abscess the process becomes chronic in 70-75% of the patients
Pyogenic abscess are drained by semilunar incisions on both sides.