The concept of paraproctitis
Acute abscess - an acute inflammation paraproctium due to the spread of inflammation from the anal crypts and anal glands.
The causative agent of infection in paraproctitis inmost cases is mixed microflora. Most often found Staphylococcus and Streptococcus in combination with E. coli, Proteus. Often (especially in ulcers pelviorektalnogo space) detected the presence of Bacteroides, peptokokki, fuzobakterii relating to Non-spore anaerobes. Acute abscess caused by mixed microflora, usually referred to as a simple, banal. Specific infections (tuberculosis, actinomycosis, clostridia) - a rather rare phenomenon. When paraproctitis, especially chronic, it is necessary to rule out TB infection.
Contributing factors of purulent process are:
- weakening of local and humoral immunity in exhaustion, alcoholism, as a result of acute or chronic infection (tonsillitis, influenza, sepsis)
- Vascular changes in diabetes, atherosclerosis
- functional disorders (constipation, diarrhea)
- presence of hemorrhoids, anal fissures, kriptita
Causes of acute abscess
The anatomical boundary between the rectum andanal canal passes through the anorectal line. At this level are morganievy crypt - pockets, the bottom of which is located approximately at the boundary of the upper and middle thirds of the anal canal. At the bottom of the crypts open ducts of the anal glands. Sami gland in the bulk are located in the interior of the inner sphincter, for what they are called yet intramuscular glands. Anal gland and morganievy crypt - a very important element in the mechanism of abscess. Intramuscular gland laid during fetal development, and the child is born with them, but they begin to function with the period of puberty. For this reason, abscess associated with inflammation of the crypts and glands, usually occurs in adults. In young children, the infection in the tissue gets, usually through the affected skin, and the newborn abscess is often the local focus of infection at septicopyemia (the presence of pathogenic microorganisms in the blood), which is confirmed by the fact that when paraproctitis children planted usually monomikrobnaya staphylococcal flora , while in adults polymicrobial flora with the indispensable participation of pathogenic intestinal microorganisms.
Anal glands are readychannels, in which the infection penetrates into the lumen of the colon. If there is a blockage of the gland duct due to mucosal edema of the rectum (for diarrhea), microtrauma, scarring excretory ducts of the glands (the transferred crypto), etc., may develop acute inflammation group anal glands that open into the crypt (crypt), and thus microabscesses way there in the wall of the anal canal.
Microabscesses caused due to inflammationglands, initially localized in the crypt, and does not extend beyond the internal sphincter, and under favorable circumstances can to empty through the crypt. At this stage, the disease can be regarded as a crypto. But if the abscess extends deep into, t. E. Mezhsfinkternoe in space, then it's abscess. According partitions mezhsfinkternogo space pus can go in different directions, causing the formation of ulcers in the broader adrectal cellular spaces.
According to the localization of abscess are distinguished:
- subcutaneous abscess
- submucosal abscess
- ishiorektalny abscess
- pelvic abscess, rectal
Localization crypt involved in the processinflammation, abscess may be back, front or side. In the first place it is back on the frequency of abscess, the second - the front, less often affects the crypt on the side walls. More frequent loss of crypts at the back wall can be explained by the fact that the rear of the crypt deeper and worse drained, they are more often injured solid feces due to the rigid fixation of the bowel wall at the back of the semicircle, as well as the fact that the rear crypts offer much more ducts anal glands.
Another important element in the development chainacute purulent abscess is a course on which the pus from mezhsfinkternogo space falls into the more remote areas. Localization of this move is crucial when choosing the method of operation. The fact that the pus from the intermuscular space can get into another cellular spaces, bypassing the external sphincter of the anus or passing through it. The following options are available: stroke is located inwards from the outer pulp, the process goes through the subcutaneous portion of the sphincter, through the deeper layers - superficial and deep portion of the muscle, the course goes around the sphincter to the lateral side - ekstrasfinkterny move.