Acute paraproctitis is an acute inflammatory disease of pararectal tissue. Infection from the rectum through the ducts of the anal glands can quickly penetrate into one of the pararectal cellular spaces - subcutaneous (most often), ischiorectal, pelviorectal, retrorectal (very rare).
According to the names of these spaces, the form of acute paraproctitis is also named - submucosal, subcutaneous, ishiorectal, pelviorectal (pelvic rectal), retrorectal. Sometimes there is an intrasphincteric abscess, but this term is better used in chronic paraproctitis, because it is difficult to accurately localize the abscess cavity in an acute process. The internal opening of the abscess is almost always one, and there can be two or more external abscesses, and these external abscesses are often located on both sides of the anus - behind or in front of the rectum (horseshoe-shaped paraproctitis). The "arc" of such an abscess passes behind, between the anus and the coccyx (more often) or in front of the anus (in women, between the anus and the rectovaginal septum). In this case, respectively, a posterior or anterior horseshoe-shaped acute paraproctitis is diagnosed, and on the one hand the abscess can be subcutaneous, and on the other ishiorectal, etc. Most often, in more than half of all patients, the abscess is located on the border of the skin and mucous membrane - subcutaneous submucosal marginal acute paraproctitis. A very unpleasant disease.
It can be difficult to determine the internal opening of the abscess at the height of the inflammation; on palpation, only the painful ("interested") wall of the anal canal is determined, most often the posterior one, since the deepest and widest anal crypts are located on the posterior wall of the anal canal, and it is here that in most cases the primary cryptoglandular abscess is formed.
There are relatively few patients with primary acute paraproctitis in the abscess stage; The abscess is usually opened (pierced its front wall) in the clinic, or the abscess is opened spontaneously after traditional home treatment - warm baths, compresses with ichthyol or with Vishnevsky's ointment. In such cases, an external examination shows a small purulent wound near the anus, and with a digital examination it is almost always possible to establish the localization of the internal opening. With spontaneous or even surgical opening of the abscess without treating the internal opening of the abscess, radical cure does not occur, and therefore, in acute paraproctitis (including with spontaneous opening of the abscess), a radical intervention is indicated under anesthesia.
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