In the development of paraproatitis, the leading role is played by the weakening of local immunity, the decrease in which occurs under the action of pathogenic microflora. Not the last role in the development of paraproctitis is played by vascular changes in diabetes and atherosclerosis.
Content
The concept of paraproject
Acute paraproctitis - acute inflammation of the octic fiber due to the spread of the inflammatory process from the anal crypt and the anal glands.
The causative agent of infection in paraproctite in most cases is a mixed microflora. Most often, staphylococci and streptococci are found in combination with an intestinal wand. Often (especially in the pebniques of the pelviorectic space) the presence of bacteroids, peptococci, fuzobacteria belonging to non-correlacing anaerobam is found. Acute paraproctitis due to mixed microflora, is usually called simple, banal. Specific infection (tuberculosis, actinomycosis, clostridia) - a rather rare phenomenon. With paraproject, especially chronic, you must definitely eliminate tuberculosis infection.
The predisposing factors of the occurrence of the purulent process are:
- Weakening of local and humoral immunity during exhaustion, alcoholism, due to acute or chronic infection (angina, influenza, sepsis)
- Vascular changes in diabetes, atherosclerosis
- Functional disorders (constipation, diarrhea)
- The presence of hemorrhoids, cracked the rear pass, cryptite
Causes of acute paraproctitis
Anatomical border between the rectum and the anal canal passes through the anorectal line. At this level, Morganiev crypts are pockets, the bottom of which is located approximately on the border of the upper and middle third of the anal canal. At the bottom of the crypt, outlets of the anal glands. The glands themselves are localized in the thickness of the inner sphincter, for which they are called even intramuscular glands. Anal glands and Morganiev Crypts are very important elements in the mechanism for the development of paraproatitis. Intramuscular glands are laid during the period of intrauterine development, and the child is born with them, but they begin to function from the occurrence of sexual maturity. For this reason, paraproeats associated with the inflammation of crypt and glands, more often occurs in adults. In young children, infection in fiber falls, as a rule, through the affected skin, and in newborns, paraproatitis is often a local focus of infection during septicopemia (the presence of pathogenic microorganisms in the blood), which is confirmed by the fact that a monomicrous staphylococcus flora While adult flora polyimicrobial with indispensable participation of pathogenic intestinal microorganisms.
Anal glands are ready-made channels in which infection is penetrated from the lumen of the rectum. If there is a blockage of the grade of the gland due to the edema of the mucous membrane of the rectum (with diarrhea), microtrauma, scar changes of the output grooves (transferred cryptite) and T.D., An acute inflammation of the anal gland groups opened in a crypt (crypts) may develop, and thus the microabscesses in the wall of the anal canal.
MicroBSsess, resulting from inflammation of the glands, at first localized in the crypt area and does not go beyond the internal sphincter and with a favorable coincidence may empty through the crypt. At this stage, the disease may be regarded as cryptite. But if abscess spreads deep into, t. E. into intersphine-space, then it is already paraproititis. According to the partitions of the intersphistribution space, the pus can go in different directions, causing the formation of glands in more extensive paralegant cellular spaces.
On the localization of the affectionant distinguish:
- subcutaneous abscess
- Ploycochetic abscess
- Ishiorectal abscess
- Tazo-direct abscess
On localization of crypts involved in the process of inflammation, paraproctitis can be rear, front or side. In the first place in frequency it is the rear paraproxy, on the second - front, less often the crypts are affected on the side walls. The more frequent defeat of the crypt on the rear wall can be explained by the fact that the rear crypts are deeper and worse drained, they are more often injured by the solid feet due to the tougher fixation of the intestine walls along the rear semi-rareness, as well as the fact that in the rear crypts it opens significantly more anal ducts iron.
Another important element in the chain of the development of acute paraproatitis is a purulent course, according to which the pus from the intersphinestone falls into more distant zones. The localization of this stroke is crucial when choosing a method of operation. The fact is that the purple of the intermuscular space can get into another cellulum space, bypassing the external sphincter of the rear pass or passing through it. The following options are: the move is located knutrice from the outer zom, the move goes through the subcutaneous portion of the sphincter, through the deeper layers - the surface and deep portion of the muscles, the move is envelopes the sphincter from the lateral side - the extracefincount.
