How is the operation to remove paraproctitis. Paraproctitis, what is it? Causes and methods of treatment Before and after paraproctitis surgery

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Paraproctitis - or a chance for the first visit to the proctologist.

There are diseases that are not “accepted” to talk about. Usually these include diseases of the genital organs and the anus, that is, those that relate to the intimate and deeply personal sphere of a person, to his own and secret biological life.

But then the moment comes when the disease begins to disturb and disturb so much that all fears, false modesty are discarded, and for the first time in life (we hope that it will be the last, in a good sense of the word), the patient climbs into a chair in the proctologist's office.

Moreover, it is not at all necessary that it is the rectum that will be “guilty”. For example, there is such a disease as paraproctitis. This process can occur in everyone, in the same way as each of us can experience (and more than once) a pustular skin lesion. What is this disease, how does it manifest itself, and how to get rid of it?

Paraproctitis - what is it?

A person familiar with medical terminology does not need to explain anything. The term, as often happens, is compound: the suffix "-itis" indicates the inflammatory nature of the lesion, and the second part para + procto means next to or near the rectum.

Paraproctitis is an inflammatory disease of tissues adjacent to the rectum. What are these fabrics? This is the fiber that lies around the rectum.

This fiber is loose, with a good blood supply. After all, the anal region must be mobile, and a person has a special muscle that lifts the perineum - levater ani. This muscle also lifts the rectum. Moreover, its work is synchronized with the rectal sphincter. It is this rise of the perineum that allows you to complete the act of defecation.

If the rectum were rigidly fixed, this would not be possible. Therefore, it is surrounded by muscles and fiber, which contributes to its mobility. It is in this fiber that inflammation occurs, which is called paraproctitis.

We can say that almost half of the diseases of the rectum is represented by paraproctitis. More often than not, only hemorrhoids, anal fissures and inflammation of the colon, or.

Causes of paraproctitis

As they say, you don’t have to go far for the pathogen. In the faeces, which are often excreted from the rectum, they abound. Most often, the usual E. coli takes an active part in the development of the disease. It is she (together with other microorganisms) that causes the disease.

It remains to understand how it gets inside the fiber. After all, for this you need to overcome the protective barrier of the skin of the perineum - this can happen in the following ways:

• Through the anal glands, which are located on the surface of the rectum;
• through the wall of the rectum, in case of damage, for example, with anal fissures;
• From neighboring genital organs, or from the perineum, in case of inflammation developing there. Such diseases include bartholinitis, prostatitis, salpingitis;
• It is believed that sometimes this process can "go down" from the sigmoid colon in Crohn's disease, as well as in ulcerative colitis.

In addition to these ways and causes, paraproctitis can develop when and when there is intensive combing of the perineum. In the event of chronic, non-healing wounds, the infection can get from the surface of the skin to deeper tissue.

The basis of paraproctitis is an inflammatory infiltrate. In some cases, when a large amount of pus occurs, this infiltrate "melts" and various pus streaks occur that spread to different areas of the perineum. A complication of the disease is the formation of fistulas, which will be discussed later.

Forms of paraproctitis

Like all diseases, paraproctitis has its own classification. One of the most common is the following:

• According to etiology, acute paraproctitis is divided into vulgar (usual), caused by anaerobic (clostridial) flora, specific (tuberculous, syphilitic processes). There is also traumatic paraproctitis;
• Localization of the infiltrate, as well as its derivatives - for example, streaks of pus and fistulas. So, they distinguish between the subcutaneous form, ischial-rectal, posterior-rectal, submucosal, pelvic-rectal, necrotic and chronic forms of the disease;
• In the event that there are fistulas, they can be formed (complete), incomplete, as well as external (which is more favorable) or internal.

In addition, there are special classifications, for example, according to the location of the fistula opening.

Symptoms of paraproctitis in humans

The clinical symptoms of paraproctitis are very bright: there is a gradual pain in the perineum, in the anus, which is aggravated by defecation, while walking. There is swelling of the tissues, a feeling of heat, pain on palpation.

Then there are common signs of paraproctitis - this is fever, chills, loss of appetite. In the event that the infiltrate breaks into the rectum (that is, back), then there is a discharge of pus from the anus, this is associated with an improvement in the patient's well-being.

Such a case ends with spontaneous recovery. Sometimes chronic paraproctitis or complications of the disease can form.

Unfortunately, complications are associated (mainly) with untimely seeking medical help. People use folk remedies, apply herbs, do baths and douches - and at this time pus accumulates in the focus of inflammation.

Fistula with paraproctitis

Acute purulent paraproctitis can be complicated by fistulas. A fistula is a subcutaneous passage that lies between the anal gland and the skin, such as the perineum. We can assume that this is the outlet, where the abscess broke through. This external fistulous tract may continue to secrete pus.

In this case, it is believed that the fistula is functioning, that is, the abscess has simply emptied. This, of course, brings relief to the patient.

But sometimes fistulas can lead anywhere, and break through, for example, into the scrotum, into the abdominal cavity or into the vagina. In the first case, in addition to the fistula, peritonitis occurs, which cannot be cured without surgery already on the abdominal cavity.

But even if the external opening of the fistula began to secrete less and less pus, and then closed, this does not mean anything. The fact is that there, in the primary focus, a purulent process can continue, and, upon reaching a certain pressure on the tissues of the external opening of the fistula, it will break through again. Thus, a chronic fistula will be formed, which will be a constant "time bomb".

• Interestingly, the incidence of fistula formation is about 50%. With ordinary paraproctitis, it is impossible to guess whether there will be a fistula, and where it can break through.

As for other complications, they occur more rarely, but this does not make them less serious. For example, these are states such as:

• Purulent fusion of the rectal wall. This process in women can go to the wall of the vagina;
• Deep leakage of the erupted infiltrate with spread to the pelvic tissue;
• The exit of the contents of the rectum after the melting of its wall into fiber;
• The development of peritonitis, or leakage of pus into the retroperitoneal space;
• Hemorrhoids and paraproctitis, "meeting together", can cause bleeding due to purulent fusion of the hemorrhoid;
• Finally, purulent fusion of the walls of the urethra can also occur. After that, it will be necessary to carry out plastic surgery to form a new urethra.

Features of chronic paraproctitis

Chronic paraproctitis appears if the acute form could not be cured. It also forms with reduced immunity. In general terms, the clinic of chronic paraproctitis is more blurred, with an undulating course.

This is due to the periodic release of pus through the formed pararectal fistula. In the event that this fistula is short, straight and wide enough, then the patient may not experience any discomfort.

And if the fistula is long, curved, and drainage through it is poor, then defecation is needed to empty the focus. The pressure in the abdominal cavity increases and the fistula opens.

At the same time, pain and discharge of purulent masses appear during defecation, and after that a “temporary lull” occurs again.Such fistulas with and chronic paraproctitis are called incomplete.

Diagnostics

As a rule, the diagnosis of paraproctitis, especially acute and vulgar, is quite simple. Based on the patient's complaints, and the initial examination by the proctologist, one can notice redness, swelling and severe pain in a certain place of the rectal tissue.

To the touch this place will be hot (if the focus is not deep). When trying to percussion (percussion) over the site of paraproctitis, the stage can be determined:

• In the event that it is a dense infiltrate and there is no suppuration (or it is slightly expressed), then the density will be comparable with the surrounding tissues.
• If there is a significant amount of molten pus deep under the skin, then there will be an impression of tapping on soft dough.

As a rule, such diagnostic methods are quite enough. Usually, neither CT nor MRI is used, since the only treatment for paraproctitis is surgery. During the surgical intervention, an accompanying revision is carried out and, if necessary, the operation area is expanded.

Treatment of paraproctitis - operation and features

As mentioned above, conservative therapy for acute paraproctitis is impossible - it's the same as trying to cure - the outcome will be the same. If a diagnosis of "acute paraproctitis" is made, only charlatans can offer treatment without surgery.

• And you need to try to make sure that the operation is performed in a special department of proctology, and certified surgeons - proctologists.

And that's why:

In principle, this operation can be quickly performed in any department of purulent surgery. But there is one small subtlety here: in the department of purulent surgery they will do what they are usually used to doing, namely: they will open the abscess, empty it, and drain the cavity.

And the specialist will still cut, and then block the passages through which the infectious process spreads through the fiber. This can only be done by a proctologist, for whom the perineum is “home”.

If you simply open and drain the abscess, then the risk of a fistula appearing after a paraproctitis operation increases significantly, or a chronic form of the disease occurs.

Therefore, all surgical procedures must be performed by a proctologist. Especially when it comes to the treatment of paraproctitis in children.

Forecast

In the event that the patient turned to a specialist on the first day - two after the appearance of unpleasant sensations in the perineum, with the discovery of a "hot bump", that is, as soon as he realized that he did not go away on his own - no need for lotions and baths. You need to contact a proctologist.

• In this case, with a probability of almost 100%, the treatment will lead to recovery.

In the event that home baths are carried out until the fistula breaks into the abdominal cavity, then it will be very difficult to talk about the prognosis, because then the first place will not be the quick treatment of paraproctitis, but saving the patient's life in purulent intensive care, after abdominal surgery for about peritonitis.

But it doesn't end there: paraproctitis needs treatment even after surgery.

What happens to patients with paraproctitis immediately after surgery? What can and cannot be done? First of all, you need to follow all the instructions and recommendations of the doctor and nurse. The effect of anesthesia ends shortly after waking up. In the area of ​​the postoperative wound, pain and discomfort are possible. If these sensations are strong, then various painkillers are prescribed.

Eating and drinking is allowed a few hours after surgery. Food should be light, sparing. You can not eat gas-producing foods, fried, highly salty or sweet, as well as spicy.

A bandage is applied to the wound after surgery for paraproctitis, which is removed the next day. This may cause discomfort.

The chair is usually restored after 2-3 days, otherwise a cleansing enema is prescribed. The terms of stay in the hospital can vary from several days to a week or even more, it all depends on the complexity of the surgical operation, the condition of the sick person, and his well-being.

Acute paraproctitis: treatment after surgery

So, the main points in the case of an acute process will be:

1. Every day the wound is bandaged using antiseptic agents (chlorhexidine, dioxidine, betadine, iodopyrone, etc.) and antibacterial ointments (levomecol, fusimet), as well as methyluracil to accelerate tissue regeneration. At the same time, during each dressing, the doctor checks the correctness of healing, as if “opening” the wound so that regeneration occurs from the bottom. This event may be uncomfortable, in which case painkillers will be prescribed.
2. Physiotherapy treatments (after consultation with a physiotherapist):

• ultraviolet irradiation
• UHFW
• microwaveW

The most suitable procedure is chosen, it is carried out in the hospital every day for 10 minutes, the total duration is from 5 days to 2 weeks, sometimes more.

These activities are carried out as a treatment for acute paraproctitis after surgery, both radical (simultaneous), and after the first stage of multi-stage intervention.

Chronic paraproctitis after surgery

As a rule, surgical treatment for the chronic course of this disease is carried out in a planned manner, so patients most often feel better in the postoperative period, complications are less common. Treatment after surgery is similar to those activities that are necessary in the case of acute paraproctitis:

1. Daily dressings with antiseptics and local antibacterial drugs.
2. The use of systemic antibiotics according to indications: if there is a strong postoperative inflammation in the wound, after plastic surgery for rectal fistula.
3. The use of laxatives and the appointment of a diet according to indications: also after plastic surgery. The diet is aimed at softening the stool: lactic acid products, dried fruits, limiting vegetables, raw fruits.

What to do at home?

After discharge from the hospital, the treatment of paraproctitis after surgery continues. Firstly, a sick person alone or with an assistant will need to continue dressings. The technique will be shown by the doctor in the hospital before discharge. Sometimes, if it is impossible to make dressings at home, you can go to the clinic to see a surgeon.

Wound care at home is not difficult: it does not require complete sterility. For dressing, you need a bandage or gauze folded in several layers, an antiseptic (hydrogen peroxide, chlorhexidine - can be purchased at any pharmacy), as well as antibacterial ointments (levomekol is usually found in every home). With an antiseptic solution using gauze, you need to gently clean the wound, then dry it and treat it with ointment. It is not necessary to put a bandage or gauze in the wound itself so that the outflow from it is not disturbed, the bandage must be applied on top of the wound. Growing hair should be carefully trimmed or shaved. After a bowel movement, it is worth doing sitz baths or simply washing the surgical incision with antiseptics. If the discharge from the incision is bothersome, you can use pads to protect your underwear.

Bloody discharge from a wound or rectum after surgery for paraproctitis is normal. If bleeding occurs, contact your doctor immediately.

Treatment of paraproctitis after surgery: non-healing wound

First of all, it is necessary to understand that the postoperative period (that is, the period until complete healing) in the case of paraproctitis is at least 3 weeks. Sometimes, depending on the complexity and volume of the operation, this period may take longer. Dressings are usually done 3-4 weeks. Even making dressings at home, you need to periodically go through a checkup with a surgeon, preferably a proctologist.

If you are concerned that during treatment after surgery for paraproctitis, the wound does not heal, you must definitely inform your doctor about this. Sometimes it happens that paraproctitis, especially chronic, with the presence of a fistula, cannot be cured. Then, on palpation, it will be determined by an overgrown fistula. In this case, a second operation is necessary, but usually not earlier than a year later. In some cases, a non-healing wound may be associated with bacterial complications. In such a situation, antibiotics are prescribed locally and systemically (in tablets or injections).

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16 comment(s) to “Treatment of paraproctitis after surgery”

The operation was in the first month of my life, pus is still coming, what should I do?

Re-do. Go to the surgeon who did you. It's been 6 weeks since my surgery. And today there is blood. Doesn't want to live.

We tried many drugs until we were advised to apply in the City of Moscow, Best Clinic. And they did not regret it, they offered us treatment with the new PlasmaJet device. Already after the first procedure, my husband felt better. We performed several procedures with this apparatus, and thank God he is healthy. The wound was closed.

Almost 2 months have passed, but a small pus remains inside the wound, what should I do? Don't say it's a fistula

I had an operation on 01/13/2014, a year for paraproctitis. It will be almost a year now, and the pus is still coming.

helped! after each toilet in the shower, then rub with tincture of calendula, then apply sea buckthorn oil. I've tried everything, this is the only one that worked!

Hello! I was sent home immediately after the operation, for a week at home I have been doing potassium permanganate baths 3 times a day, suppositories relief advance, and levomekol ointment, so far nothing to disturb. Has anyone had a doctor's prescription like this?

I had baths twice with manganese and on a rag levomekol and on the wound you can and candles

Hello, I had an operation for poropractitis 3 years ago, until then, pus goes on as it treats at home

I'm doing the operation for the 6th time. Vseravno again appears the formation of pus. Tired

What city are you from? I got 6 too.

Diet, and for the rest of your life you need to stop drinking alcohol. I had an operation on 08/08/17, 5 days have passed - there is no blood and pus. Diet to keep the stool soft. Before dressing, wash, then sit with potassium permanganate for 10 minutes, then clean with furatsilin directly on the wound with a syringe and then dressing with levomekol. And together take the antibiotic Cyfomet 2 times a day. Alcohol is strictly forbidden, even with complete healing. Healthy lifestyle.

My husband had an operation 3 years ago, tried everything that others advised, settled on Vishnevsky's ointment, try it, maybe it will help someone too.

Ointment Vishnevsky, helped me!

We did the operation for 5 years and my husband is suffering. And they sat in potassium permanganate and applied ointments, nothing helps ...

Surgery to remove paraproctitis

Paraproctitis is a disease of pararectal tissue, characterized by the presence of an inflammatory process and the formation of a purulent abscess in the anus. This pathological condition develops as a result of infection on the rectal mucosa. Among the possible routes of entry of pathological microorganisms, the most likely are: through damage to the anus, with anal fissures, hematogenously (through the blood), through the structural elements of the lymphatic system, as well as from neighboring organs affected by the inflammatory process. A person suffering from this disease experiences severe discomfort and pain, which significantly impairs the quality of his life.

The main symptoms of this disease:

• fever, chills;
• general malaise, weakening of the body;
• pain in the perineum, pelvis, aggravated during the act of defecation;
• painful infiltrate, hyperemia in the case of an abscess located near the surface of the skin.

Treatment of pararectal abscess

There is an opinion that paraproctitis can be cured with the help of conservative therapy. However, doctors say that the only possible way to treat this inflammatory process is an operation aimed at excising the abscess.

Carrying out such a radical method of treatment is mandatory at any stage of the disease. The operation performed at the initial stages provides a guarantee of a complete cure for the disease. Depending on the location of the abscess, its prevalence, as well as the severity of the course, the operation may be different. The type of surgery is determined by the doctor after a thorough examination and examination of the patient. Surgical treatment of paraproctitis is mandatory and urgent, therefore it is carried out immediately after the diagnosis is confirmed. The main goal of the surgical treatment of paraproctitis is to search for a purulent abscess, open it, drain it, cut out the affected crypt and purulent canal, and also eliminate the connection with the large intestine.

Even "neglected" hemorrhoids can be cured at home, without surgery and hospitals. Just remember to apply once a day.

In surgical practice, the following types of operations are used:

• opening of the abscess and its purification from pathological contents (drainage). Also, excision of the inflamed crypt and excision of the abscess canal into the rectal cavity;
• opening the abscess, removing all its contents + performing sphincterotomy;
• ligation, except for opening and removing purulent contents;
• excision of the fistulous tract with subsequent movement of the mucous membrane to block the paths of possible entry of pathological microflora from the colon. It is carried out after dissection and cleansing of the abscess.

Surgical intervention to remove paraproctitis takes place under intravenous, epidural or mask anesthesia. Local anesthesia is not done because of the risk of expanding the infection with an injection (administration of an anesthetic).

The operation to remove paraproctitis is very difficult and requires excellent knowledge, practical skills and high qualifications for such operations. Due to the lack of experience and knowledge, complications can develop after the operation, the most common of which are sphincter insufficiency and fecal and gas incontinence. Especially when it comes to paraproctitis, which has formed deeply (with ischio- and pelviorectal type), in which it is very difficult to make the right choice of the type of operation. To make a successful operation to remove paraproctitis, it is better to contact specialized private clinics or specialized public medical institutions. Treatment of chronic paraproctitis also takes place with the help of surgical intervention aimed at carrying out such possible manipulations:

• dissection or excision of the fistulous passage into the lumen of the rectum;
• they can also make an excision in combination with opening the streaks, after which they are drained;
• the fistulous canal is excised and drained, and the sphincter is sutured (ligation).

During a sharp deterioration in the patient's condition due to the development of relapse against the background of the chronic course of the disease, conservative therapy can be carried out within the walls of the hospital. It is carried out in order to reduce inflammation, as well as reduce pain. Despite the appearance of noticeable changes, subsequent surgical treatment will still be prescribed.

The prognosis after surgical treatment is favorable, promising a complete cure. However, if surgical treatment was aimed only at breaking through the formed abscess, then complete recovery may not occur at all, and the acute process will eventually turn into a chronic one. To achieve the maximum effect, it is necessary to eliminate the connection of the abscess with the rectum. In addition, the occurrence of complications can be affected by incorrect postoperative management of the patient, as well as technical errors in the operation.

How to treat hemorrhoids at home

Have you ever tried to get rid of hemorrhoids at home on your own? Judging by the fact that you are reading this article, the victory was not on your side. And of course you know firsthand what it is:

• see blood on paper again
• wake up in the morning with the thought of how to reduce swollen painful bumps
• suffer every trip to the toilet from discomfort, itching or an unpleasant burning sensation
• Hoping for success again and again, looking forward to results, and getting frustrated by a new ineffective drug

Education: Graduated from the Russian National Research Medical University. N.I. Pirogov, Faculty of Medicine. Took advanced training courses. Primary specialization - in coloproctology at the State Scientific Center of Coloproctology. Worked at the City Scientific and Practical Center of Coloproctology of St. Petersburg.

Experience: Proctologist. Experience in medical practice - 25 years. Author of more than 40 medical articles. A regular participant of conferences and symposia, which highlights the problems of modern medicine.

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PROCTOLOG81.RU / Coloproctology (proctology). Treatment. / treated a crack, but it turned out to be paraproctitis

Lord, how is it possible that proctologists make different diagnoses. Who to trust now? The new doctor prescribed a bunch of pills and suppositories for 10 days. He said that we'll see how the sore behaves, he said that in 80% of cases it is necessary to remove it surgically.

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Do you have any questions? Call! from 10:00 to 20:00

"KDS CLINIC" - Coloproctology

Do you have any questions? Call! from 10:00 to 20:00

"KDS CLINIC" - Coloproctology

Do you have any questions? Call! from 10:00 to 20:00

How is the operation for paraproctitis

Paraproctitis is an inflammatory process in the rectum. This disease is as common as hemorrhoids, colitis and others. Regardless of the severity and course of the disease, the patient needs a paraproctitis operation suitable for the patient.

This disease develops due to the appearance of an infection on the mucous membrane of the rectum. According to statistics, more men suffer from paraproctitis than women.

The main signs and causes of the development of the disease

Symptoms of the disease depend on the focus of inflammation, its location and size. In addition, the symptoms in acute and chronic paraproctitis are slightly different. The acute course of the disease is characterized by pronounced aggressive signs, which decrease over time and the patient feels much better. After some time, the symptoms of the disease appear again.

In chronic paraproctitis, the signs of the disease are less pronounced, relief lasts a longer period of time.

The main symptoms of paraproctitis:

• general weakness and malaise;
• the occurrence of pain in the sphincter and perineum, aggravated after bowel movements;
• the development of a fistula in the chronic course of the disease;
• elevated temperature;
• the appearance of headaches;
• regular constipation;
• violation of urination.

Detection of any signs of the disease is a serious reason for visiting a doctor. A qualified specialist should conduct an examination and prescribe treatment, mainly in the form of a surgical intervention. The type of operation depends on the course of the disease, the size and location of the abscess. Delay is fraught with the development of complications. If left untreated, tissue necrosis and fistula formation occur.

The cause of the development of the inflammatory process is often the penetration of infections into the rectum. The main causative agents of the disease are Escherichia coli, staphylococcus aureus or enterococcus, which quickly spread through the intestines and penetrate into the folds of the anus.

Timely treatment of paraproctitis can guarantee complete relief from this disease. At an early stage of the development of the disease, therapy without surgical intervention is possible.

Another cause of the disease is the transmission of infection through the blood. Microtrauma and fissures of the anus also contribute to the development of the disease.

Often the development of paraproctitis is preceded by diseases such as hemorrhoids and chronic constipation.

Operation in the acute phase

To confirm the diagnosis of "acute paraproctitis", a comprehensive examination is carried out, after which the patient is placed in a hospital, where he is prescribed the only possible treatment for the removal of abscesses and fistulas - surgery.

There are several types of operations for acute paraproctitis, which are selected based on the patient's condition. They can be single or multiple. Due to the fact that the muscles should be as relaxed as possible, all types of operations are performed under general or epidural anesthesia.

Options for simultaneous surgical intervention in the acute stage of the disease:

1. Opening of the abscess with subsequent drainage and excision of the sinus and purulent passage. This method is effective in case of damage to the subcutaneous layer or in case of localization of the course inside the sphincter.
2. With intersphincteric pathology, an abscess is opened, drainage and excision of the anal sinus.
3. With trans- and extrasphincteric paraproctitis, the abscess is cut in order to cleanse from purulent masses and the crypt is excised.

Simultaneous types of surgery require highly qualified surgeons and are performed in rare cases. To carry out this kind of intervention, it is necessary to know the exact location of the abscess, the purulent course and other factors.

Contraindications for this type of operation:

• severe weakness of the body;
• senile age of the patient;
• tissue susceptibility to severe inflammation in the area of ​​the operation;
• the localization of the affected anal sinus has not been determined.

Multi-stage interventions occur in several stages. At the first stage, the abscess is opened and purulent masses are removed. After healing of the tissues in a period of about one week, the second stage is carried out, during which the affected anal sinus and glands are removed.

The difference between these operations is only in the need for healing in the second method of intervention, otherwise all measures to remove the abscess are identical.

Surgery for a chronic form

Untreated acute paraproctitis takes a chronic form of the disease with the presence of a fistula in the soft tissues, which requires surgical treatment.

Surgery for chronic paraproctitis can be planned or emergency.

Planned treatment is most effective and shows a more favorable result. In this case, preparation for surgery is required using anti-inflammatory and antibacterial drugs.

Removal of the fistulous tract is the main goal of surgical intervention, the implementation of which depends directly on the location of the fistula. It is possible to determine the exact location of fistulas using dyes or x-rays.

In chronic paraproctitis, the following activities are carried out:

• excision or dissection of the fistula;
• sphincter closure;
• ligature method;
• using sealing tampons;
• obliteration of the fistula with a laser.

The choice of method directly depends on the location of the fistula and other factors affecting the course of the operation.

Postoperative period

To speed up relief after the operation and achieve a quick recovery, the patient must follow some rules.

1. First of all, this is the observance of the prescribed diet with the exception of fatty and spicy foods. The patient's diet should include fermented milk products, boiled meat and fish, dairy-free cereals. The drinking regimen is very important. Drink at least 1.5 liters of pure water daily.
2. During the treatment period, alcohol and smoking are completely prohibited.
3. It is very important to follow the doctor's recommendations and take medicines in a timely manner, put rectal suppositories, use antibacterial ointments and regularly take baths with the addition of medicinal herbs.

With good recovery results, the patient spends several days in the hospital. However, you should continue to do daily dressings at home.

Consequences of refusing surgery

Failure to timely remove paraproctitis or self-medication is fraught with many serious complications, such as:

• strengthening of the inflammatory process and the development of phlegmon;
• acute peritonitis due to infection in the abdominal cavity;
• sepsis;
• development of chronic paraproctitis;
• purulent lesion of the pelvic organs or purulent paraproctitis.

Especially dangerous is the ingress of purulent masses into the pelvic organs, since with untimely medical care this can cause death.

Each person must take care of their own health. When the first signs of paraproctitis appear, you should contact a surgeon or proctologist and not refuse surgery. Early surgery can save a life.

Treatment of paraproctitis with an operative method: description and consequences

Rectal disease - paraproctitis is one of the most common proctological pathologies. The process of inflammation affects the tissues surrounding the rectum. Since its treatment in the acute period necessarily requires surgical intervention, patients with this diagnosis try to find out as many details about it as possible.

What it is

Paraproctitis occurs in most cases in men, in about 60-70%. In terms of prevalence, it is put in 4th place after hemorrhoids, anal fissures and colitis. The disease according to the activity of the inflammatory process is chronic and first detected (acute).

Surgery for acute paraproctitis is almost always required, but many are afraid to go under the knife. To make sure of its necessity and benefits, it is better to look at the photo of the buttocks before and after paraproctitis surgery.

The acute form of the disease, in addition to pain in the anal canal, includes signs of intoxication (nausea, weakness, etc.). It can be provoked by hemorrhoids, anal fissures or inflammation of the anal glands.

Purulent inflammations are localized in different tissues, therefore, submucosal, subcutaneous, ischiorectal, pelviorectal, retrorectal are isolated.

However, the inflammatory process itself is usually caused by various infectious pathogens:

Operation on paraproctitis

Since the disease is very severe and there is no opportunity for conservative treatment, the only way out is surgery. After the diagnosis is made, it is necessary to intervene as soon as possible if the paraproctitis is acute. However, it is also important to treat paraproctitis after surgery and comply with all prescriptions.

If there is no recurrence, then conservative treatment is possible. Usually prescribed non-hot sitz baths with medicinal solutions, compresses, microenemas and antibiotics.

Preoperative preparation

To determine the course of the procedure, it is necessary to find out the nature of the course of acute paraproctitis. A favorable course according to statistics occurs only in 10-15% of cases. In total, 4 main streams are distinguished among them:

• pus comes out, and self-healing occurs;
• pus comes out, and inside, surrounding tissues and organs become inflamed, blood poisoning occurs;
• the focus with pus is not completely emptied and there is a constant chronic inflammation;
• pus comes out completely, but the course and focus themselves become inflamed.

Preparation for the operation of paraproctitis does not take much time and does not require serious manipulations. Children under one year of age are prescribed a cleansing enema no more than a day before surgery. In this case, there must be no exacerbation of paraproctitis.

For older children and adults, as a preoperative preparation, sitz warm baths are prescribed 2 times a day for 3-5 days before surgery. If a fistula has formed, then its course is washed with a solution of furacilin or rivanol.

On the day of the operation, cleansing enemas are done, and in the evening the day before, with an antiseptic solution. The diet should contain dairy products. You need to exclude meat, legumes, some vegetables. It is necessary to follow a diet after paraproctitis surgery.

If the course of the disease is acute, then patients need to undergo a course of antibacterial and anti-inflammatory therapy. After the inflammation subsides, surgery should be performed as soon as possible to avoid recurrence.

In cases such as old age, weakened immunity, severe illness, it is not always possible to perform an operation. Therefore, they try to improve the condition with conservative treatment, only after that to operate.

There are times when conservative methods give good enough results to postpone surgery.

Operation progress

After carrying out all the preparatory procedures, an operation is prescribed, which lasts no more than 30 minutes. Anesthesia is used only sacral or epidural. The operation for the treatment of paraproctitis involves two steps: excision of the abscess or opening and draining the abscess.

To understand how much paraproctitis heals after surgery, it is necessary to take into account the age and individual characteristics of the organism.

An urgent operation to open an acute paraproctitis is performed only if there are indications for that. The procedure cannot be performed if the tissues around the site of the surgical incision are inflamed and if the location of the anal sinus is unknown.

The operation for acute paraproctitis can go in three ways:

• First, the abscess is opened, drained, then the sinuses and the purulent passage into the rectum are excised. This option is appropriate if the course is located inside the external sphincter and if only the subcutaneous layer is affected.
• With an intersphincteric inflammatory process, an abscess is opened, the contents are drained, the anal sinus is excised, and a sphincterotomy is performed.
• With trans- and extrasphincteric paraproctitis, an abscess is cut, purulent masses are removed, crypts are excised, and a ligature is applied for drainage. As a result of such an operation, a good outflow of content appears.

Most often, a multi-stage operation is performed, which involves several stages. At the first, the abscess is opened and the contents are removed. At the next stage, after about 5-7 days (depending on tissue healing), the anal sinus and glands are removed. The technique of opening subcutaneous paraproctitis depends on the nature of the inflammation.

After operation

Treatment of acute paraproctitis after surgery includes complex therapy. If there are no complications and healing is normal, then the patient is allowed to go home after a few days.

Healing itself after an uncomplicated operation lasts up to 10 days, and a purulent wound heals completely only within 4 weeks.

Almost always, antiviral and antibiotics are prescribed to avoid the inflammatory process. Cleansing enemas with drugs are also required. It is necessary to constantly apply ointments to the wound for healing.

If stool retention occurs after 2-3 days, then cleansing enemas are used. After each trip to the toilet, you need to treat the wound: sitz baths and a new dressing.

According to reviews and photos, paraproctitis before and after surgery is very different. With the steady observance of all the prescriptions of doctors, it can be cured quite quickly.

It is recommended to follow a specific diet after paraproctitis surgery to help the intestines recover. At least 5 glasses of liquid should be drunk daily. Exclude from the diet salty, sour, spicy, beans, raw fruits and vegetables, pastries and alcoholic / carbonated drinks.

Nutrition after paraproctitis surgery, what you can eat:

• semolina and rice porridge on the water;
• steamed meatballs;
• baked apples;
• boiled vegetables;
• compote;
• dairy products;
• boiled fish and meat, passed through a meat grinder;
• protein omelet.

Complications after surgery

Recurrence of paraproctitis after surgery is possible, but it depends only on individual qualities and other concomitant diseases. However, possible complications due to factors such as:

• severe intoxication;
• untimely appeal to a specialist for help;
• the postoperative period was carried out incorrectly;
• there are severe comorbidities;
• wrong operation.

Such factors can cause the re-development of the fistula, that is, cause a recurrence of paraproctitis after surgery.

Conclusion

Acute paraproctitis can be provoked by many factors. The development of the disease significantly worsens the patient's condition and reduces the quality of life. Therefore, it is necessary to consult a specialist after the first signs of the disease. This will help to avoid unnecessary complications and quickly bring the patient back to normal.

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Paraproctitis is an acute inflammatory disease in the anus, as a result of which a purulent abscess develops. It is considered a fairly common proctological ailment and gives way only to hemorrhoids, colitis and anal fissures. According to statistics, men are more susceptible to the development of this disease than the fairer sex. The reason for the development of such a dangerous disease is the infection on the mucous membrane of the rectum. The main routes of penetration of pathogenic microorganisms: through the damaged mucous membrane of the rectum, with anal fissures, hematogenous and lymphatic routes (through the blood or structural elements of the lymphatic system), as well as from neighboring organs if they are affected by the inflammatory process.

The main signs of the presence of purulent inflammation in the anus are:

• fever, shivering (chills);
• general malaise, feeling of weakness, lack of vitality;
• pain in the perineum, anus, which can become even stronger after the act of defecation;
• in the chronic course of the disease, a fistula develops (fistulous course);
• if the abscess is located in the subcutaneous tissue, there is a painful infiltrate (accumulation of cellular elements, blood and lymph).

Features of the operation for paraproctitis

It is believed that the only possible way to treat such an intimate disease is an operative intervention aimed at finding an abscess, opening it, evacuating pus, excising the affected crypt and purulent canal, and removing the connection with the rectum. There are several different types of such operations, the purpose of which is to remove the pararectal abscess.

The type of surgical intervention is determined by the doctor in each case based on the patient's condition and the stage of the disease. Each operation necessarily consists of opening the abscess and draining it. This may be followed by ligation, sphincterotomy, or complete excision of the fistula, followed by repositioning of the mucosa to prevent colonic infection. After the end of the operation, it remains only to undergo the correct rehabilitation aimed at full recovery after the surgical treatment of paraproctitis. Feedback on different types of surgery can be found on various forums. However, you should not neglect the opinion of the attending physician.

Please note that only timely surgical treatment can, to one degree or another, guarantee a complete recovery. always effective in the early stages of the disease. In more advanced cases, there is a risk of developing a chronic course of the disease, which is characterized by alternating improvements and exacerbations.

As mentioned above, after the completion of the operation, an equally important period of rehabilitation begins. It is very important to properly organize this process - the success of further recovery depends on it. Treatment of paraproctitis after surgery is a mandatory step that every patient must go through.

After the end of the anesthesia, the person begins to feel pain in the area of ​​​​removal of the fistula or purulent abscess. To reduce pain, various painkillers are prescribed. It happens that the patient has an increase in body temperature, and the condition worsens somewhat. If there is a high temperature, the doctor should conduct a thorough examination of the wound, its contents, and possible secretions. In some cases, antibiotic treatment may be needed.

So, what does the rehabilitation of the patient include after removal of a purulent abscess or fistula in the anus:

• daily dressing of the wound with the use of antiseptics (betadine, chlorhexidine);
• the use of antibacterial ointments on the wound area, for example, levomekol. This is done to prevent the development of a bacterial complication;
• to accelerate wound healing after removal of a fistula or abscess, special means are used for the rapid regeneration of damaged tissues (for example, methyluracil ointment);
• the doctor conducts regular monitoring of the wound healing process by opening it. An important point: healing should take place from the inside outward. Such an event is quite unpleasant and can cause severe pain. To eliminate pain, local or systemic painkillers are prescribed;
• prescribe various physiotherapy aimed at eliminating pain, accelerating wound healing after removal of a fistula or abscess, as well as preventing the development of re-inflammation. In this case, often prescribed: magnetotherapy and ultraviolet irradiation;
• after removal of the fistula in chronic paraproctitis, a course of laxatives can be prescribed, as well as a diet, the action of which is aimed at loosening the stool.

According to reviews, in the postoperative period, there may be a seal or discharge from the wound, accompanied by severe pain and discomfort. This condition requires immediate examination by a specialist. Reviews of people who have survived surgery for paraproctitis assure that there is often no effect after removal of the fistula (chronic pararectal abscess). In this case, a second operation is necessary. However, as a rule, not earlier than a year later. According to the responses of patients who suffered from constant pain after the operation, there was induration and signs of inflammation, they were prescribed conservative antibiotic therapy. And in case of no effect, the patients were again sent for a second operation.

Paraproctitis is an inflammatory process in the rectum. This disease is as common as hemorrhoids, colitis and others. Regardless of the severity and course of the disease, the patient needs a paraproctitis operation suitable for the patient.

This disease develops due to the appearance of an infection on the mucous membrane of the rectum. According to statistics, more men suffer from paraproctitis than women.

Symptoms of the disease depend on the focus of inflammation, its location and size. In addition, the symptoms in acute and chronic paraproctitis are slightly different. The acute course of the disease is characterized by pronounced aggressive signs, which decrease over time and the patient feels much better. After some time, the symptoms of the disease appear again.

In chronic paraproctitis, the signs of the disease are less pronounced, relief lasts a longer period of time.

• general weakness and malaise;
• the occurrence of pain in the sphincter and perineum, aggravated after bowel movements;
• the development of a fistula in the chronic course of the disease;
• elevated temperature;
• the appearance of headaches;
• regular constipation;
• violation of urination.

Detection of any signs of the disease is a serious reason for visiting a doctor. A qualified specialist should conduct an examination and prescribe treatment, mainly in the form of a surgical intervention. The type of operation depends on the course of the disease, the size and location of the abscess. Delay is fraught with the development of complications. If left untreated, tissue necrosis and fistula formation occur.

The cause of the development of the inflammatory process is often the penetration of infections into the rectum. The main causative agents of the disease are Escherichia coli, staphylococcus aureus or enterococcus, which quickly spread through the intestines and penetrate into the folds of the anus.

Timely treatment of paraproctitis can guarantee complete relief from this disease. At an early stage of the development of the disease, therapy without surgical intervention is possible.

Another cause of the disease is the transmission of infection through the blood. Microtrauma and fissures of the anus also contribute to the development of the disease.

Often the development of paraproctitis is preceded by diseases such as hemorrhoids and chronic constipation.

Excessive alcohol consumption, weakened immunity and diabetes also contribute to the onset of the disease.

To confirm the diagnosis of "acute paraproctitis", a comprehensive examination is carried out, after which the patient is placed in a hospital, where he is prescribed the only possible treatment for the removal of abscesses and fistulas - surgery.

There are several types of operations for acute paraproctitis, which are selected based on the patient's condition. They can be single or multiple. Due to the fact that the muscles should be as relaxed as possible, all types of operations are performed under general or epidural anesthesia.

1. Opening of the abscess with subsequent drainage and excision of the sinus and purulent passage. This method is effective in case of damage to the subcutaneous layer or in case of localization of the course inside the sphincter.
2. With intersphincteric pathology, an abscess is opened, drainage and excision of the anal sinus.
3. With trans- and extrasphincteric paraproctitis, the abscess is cut in order to cleanse from purulent masses and the crypt is excised.

Simultaneous types of surgery require highly qualified surgeons and are performed in rare cases. To carry out this kind of intervention, it is necessary to know the exact location of the abscess, the purulent course and other factors.

• severe weakness of the body;
• senile age of the patient;
• tissue susceptibility to severe inflammation in the area of ​​the operation;
• the localization of the affected anal sinus has not been determined.

Multi-stage interventions occur in several stages. At the first stage, the abscess is opened and purulent masses are removed. After healing of the tissues in a period of about one week, the second stage is carried out, during which the affected anal sinus and glands are removed.

The difference between these operations is only in the need for healing in the second method of intervention, otherwise all measures to remove the abscess are identical.

In parallel, therapy is carried out with conservative methods of treatment in the form of injections, tablet preparations and topical drugs.

Untreated acute paraproctitis takes a chronic form of the disease with the presence of a fistula in the soft tissues, which requires surgical treatment.

Surgery for chronic paraproctitis can be planned or emergency.

Planned treatment is most effective and shows a more favorable result. In this case, preparation for surgery is required using anti-inflammatory and antibacterial drugs.

Removal of the fistulous tract is the main goal of surgical intervention, the implementation of which depends directly on the location of the fistula. It is possible to determine the exact location of fistulas using dyes or x-rays.

• excision or dissection of the fistula;
• sphincter closure;
• ligature method;
• using sealing tampons;
• obliteration of the fistula with a laser.

The choice of method directly depends on the location of the fistula and other factors affecting the course of the operation.

To speed up relief after the operation and achieve a quick recovery, the patient must follow some rules.

1. First of all, this is the observance of the prescribed diet with the exception of fatty and spicy foods. The patient's diet should include fermented milk products, boiled meat and fish, dairy-free cereals. The drinking regimen is very important. Drink at least 1.5 liters of pure water daily.
2. During the treatment period, alcohol and smoking are completely prohibited.
3. It is very important to follow the doctor's recommendations and take medicines in a timely manner, put rectal suppositories, use antibacterial ointments and regularly take baths with the addition of medicinal herbs.

With good recovery results, the patient spends several days in the hospital. However, you should continue to do daily dressings at home.

If it is impossible to perform the dressing on your own, this procedure is carried out in the clinic until complete healing.

Failure to timely remove paraproctitis or self-medication is fraught with many serious complications, such as:

• strengthening of the inflammatory process and the development of phlegmon;
• acute peritonitis due to infection in the abdominal cavity;
• sepsis;
• development of chronic paraproctitis;
• purulent lesion of the pelvic organs or purulent paraproctitis.

Especially dangerous is the ingress of purulent masses into the pelvic organs, since with untimely medical care this can cause death.

Each person must take care of their own health. When the first signs of paraproctitis appear, you should contact a surgeon or proctologist and not refuse surgery. Early surgery can save a life.

is among the most common proctological pathologies. The process of inflammation affects the tissues surrounding the rectum. Since its treatment in the acute period necessarily requires surgical intervention, patients with this diagnosis try to find out as many details about it as possible.

Paraproctitis occurs in most cases in men, in about 60-70%. In terms of prevalence, it is put in 4th place after hemorrhoids, anal fissures and colitis. The disease according to the activity of the inflammatory process is chronic and first detected (acute).

Surgery for acute paraproctitis is almost always required, but many are afraid to go under the knife. To make sure of its necessity and benefits, it is better to look at the photo of the buttocks before and after paraproctitis surgery.

Photos before and after paraproctitis surgery

For older children and adults, as a preoperative preparation, sitz warm baths are prescribed 2 times a day for 3-5 days before surgery. If a fistula has formed, then its course is washed with a solution of furacilin or rivanol.

On the day of the operation, cleansing enemas are done, and in the evening the day before, with an antiseptic solution. The diet should contain dairy products. You need to exclude meat, legumes, some vegetables. It is necessary to follow a diet after paraproctitis surgery.

If the course of the disease is acute, then patients it is necessary to undergo a course of antibacterial and anti-inflammatory therapy. After the inflammation subsides, surgery should be performed as soon as possible to avoid recurrence.

In cases such as old age, weakened immunity, severe illness, it is not always possible to perform an operation. Therefore, they try to improve the condition with conservative treatment, only after that to operate.

There are times when conservative methods give good enough results to postpone surgery.

Operation progress

After all preparations have been made, an operation is prescribed, which lasts no more than 30 minutes. Anesthesia is used only sacral or epidural. The operation for the treatment of paraproctitis involves two steps: excision of the abscess or opening and draining the abscess.

To understand how long paraproctitis heals after surgery it is necessary to take into account the age and individual characteristics of the body.

An urgent operation to open an acute paraproctitis is performed only if there are indications for that. The procedure cannot be performed if the tissues around the site of the surgical incision are inflamed and if the location of the anal sinus is unknown.

Surgery for acute paraproctitis usually lasts no more than 30 minutes

The operation for acute paraproctitis can go in three ways:

• First open the abscess, drain it, then excise the sinuses and purulent passage into the rectum. This option is appropriate if the course is located inside the external sphincter and if only the subcutaneous layer is affected.
• With an intersphincteric inflammatory process, an abscess is opened, the contents are drained, excise the anal sinus and produce a sphincterotomy.
• With trans- and extrasphincteric paraproctitis an abscess is cut, purulent masses are removed, crypts are excised, a ligature is applied for drainage. As a result of such an operation, a good outflow of content appears.

Most often, a multi-stage operation is performed, which involves several stages. At the first, the abscess is opened and the contents are removed. At the next stage, after about 5-7 days (depending on tissue healing), the anal sinus and glands are removed. The technique of opening subcutaneous paraproctitis depends on the nature of the inflammation.

After operation

Treatment of acute paraproctitis after surgery includes complex therapy. If there are no complications and healing is normal, then the patient is allowed to go home after a few days.

Healing itself after an uncomplicated operation lasts up to 10 days, and a purulent wound heals completely only within 4 weeks.

Almost always, antiviral and antibiotics are prescribed to avoid the inflammatory process. Cleansing enemas with drugs are also required. It is necessary to constantly apply ointments to the wound for healing.

If stool retention occurs after 2-3 days, then cleansing enemas are used. After each trip to the toilet, you need to treat the wound: sitz baths and a new dressing.

Photo, paraproctitis before and after surgery

According to reviews and photos, paraproctitis before and after surgery is very different. With the steady observance of all the prescriptions of doctors, it can be cured quite quickly.

It is recommended to follow a specific diet after paraproctitis surgery to help the intestines recover. At least 5 glasses of liquid should be drunk daily. Exclude from the diet salty, sour, spicy, beans, raw fruits and vegetables, pastries and alcoholic / carbonated drinks.

Nutrition after paraproctitis surgery, what you can eat:

• semolina and rice porridge on the water;
• steamed meatballs;
• baked apples;
• boiled vegetables;
• compote;
• dairy products;
• boiled fish and meat, passed through a meat grinder;
• protein omelet.

Complications after surgery

Recurrence of paraproctitis after surgery is possible, but it depends only on individual qualities and other concomitant diseases . However, possible complications due to factors such as:

• severe intoxication;
• untimely appeal to a specialist for help;
• the postoperative period was carried out incorrectly;
• there are severe comorbidities;
• wrong operation.

At the first signs of paraproctitis, you should consult a doctor

Such factors can cause the re-development of the fistula, that is, cause a recurrence of paraproctitis after surgery.

Conclusion

Acute paraproctitis can be provoked by many factors. The development of the disease significantly worsens the patient's condition and reduces the quality of life. Therefore, it is necessary to consult a specialist after the first signs of the disease. This will help to avoid unnecessary complications and quickly bring the patient back to normal.