Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.
Paraproctitis
paraproctitis
•
(Pararectal abscess) - acute or chronic bacterial
inflammation of the peritoneal tissue
etiology
• Paraproctitis is one of the most frequent proctologic diseases
(20-40% of all diseases of the rectum). Paraproc...
Etiology (flora)
• E. coli;
• Anaerobes;
• Staphylococcus aureus;
• White staphylococcus aureus;
• streptococcus;
• Entero...
Pathogenesis. Ways of introduction of
infection into pararectal tissue
Columns of Morgagni
(columnae Morgani)
• Infection can penetrate through the anal glands, damaged rectum
mucosa, hematogenous and lymphogenous pathway, from
neig...
Typical ways of spreading the inflammatory
process
• The entrance gates are anal crypts, which open the ducts of the anal
...
Classification of paraproctitis.
The etiological principle distinguishes:
Nonspecific paraproctitis,
Specific paraproctiti...
Localization of abscesses
- Subcutaneous paraproctitis;
- Submucosal paraproctitis;
- Ischial-rectal paraproctitis;
- Behi...
52%
4%
42%
2%
частота различных форм
подкожный подслизистый -седалищно прямокишечный -тазово прямокишечный
• 1-subcutaneous;
• 2 submucosal;
• 3-ischial-rectal;
• 4-pelvis and rectum;
• 5- behind-rectal.
Retrorectal paraproctitis
clinics
• PECULIARITIES OF CLINIC AND PARAPROCTITIS ARE DETERMINED BY
LOCALIZATION OF THE FOCUS IN THE CELLULAR SPACES OF ...
Subcutaneous paraproctitis
• Submucosal abscess is located under the mucosa of the rectum.
Symptoms in this form of location are similar to subcutane...
• With ischiorectal abscess, a purulent focus is located above the muscle
that raises the anus. Because of the deeper loca...
• The most severe is pelvio-rectal abscess.This is a rare form of acute
paraproctitis, when the purulent focus is located ...
Chronic paraproctitis
• Manifested festering fistula.The mouth of the fistulous passage can be located near
the anal openi...
Factors of chronic course
• The internal fistula opening (covered with the epithelial lining of the mouth of an infected
o...
Diagnostics
• The basis of diagnosis are typical complaints and pains in the area of the rectum and​​
anus.When making a d...
treatment
• In the very initial stage of the disease, with a small infiltrate in the
perianal area, conservative treatment...
Operative treatment
• Surgical treatment of acute paraproctitis includes early emergency
surgical intervention by opening ...
The choice of method of anesthesia
-Infiltration anesthesia
(Vishnevsky AS, Ryzhikh AN);
- cerebrospinal anesthesia
      ...
The patient's position on the operating table
POSITION ON DEPAGE
Radical operations in acute paraproctitis can be
grouped as follows
• 1. opening and draining of the abscess, excision of ...
• Apply radial, semilunar, crosswise incisions, the most convenient of
them - semilunar and radial.They provide a gaping w...
The incisions used in
acute paraproctitis:
1 - perianal abscess; 2
- behind-mousse; 3 -
Ischiorectal.
• Surgical approaches used for ischiorectal (1) and pelviorectal (2) abscesses.
DISSECTION with subcutaneous
paraproctitis
With subcutaneous-submucosal paraproctitis, the incision is made in the radial direction
through an interested crypt.
With ischial-rectal paraproctitis, a radial incision can not be
opened, it is dangerous to damage the sphincter.
INCISION of the retrectectal paraproctitis
REASSESSMENT of abscess cavity
Complications of paraproctitis
Purulent fusion of the rectum wall with the spread of intestinal contents into the
pararect...
Complications of acute
paraproctitis
Prevention of recurrence of the disease
• To achieve a lasting effect, in addition to the radical surgery performed, it is...
Paraproctitis
Paraproctitis
Nächste SlideShare
Wird geladen in …5
×

Paraproctitis

5.161 Aufrufe

Veröffentlicht am

presentation about paraproctitis and its treatment

Veröffentlicht in: Bildung
  • 1 cup burns 1lb of diabetic fat every 72 hours... ➤➤ https://bit.ly/2mBJACQ
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • 1 cup burns 1lb of diabetic fat every 72 hours...  https://bit.ly/2mBJACQ
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • I discovered the 60-sec Habit that reversed my type 2 diabetes and melted away 56lbs of fat and discovered the real cause of diabetes... ■■■ https://tinyurl.com/y2956vb5
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier
  • I'm surprised I've seen a difference in a couple days... In a month, a big difference. I'm pretty satisfied personally with my products. ♣♣♣ https://bit.ly/2No6XLF
       Antworten 
    Sind Sie sicher, dass Sie …  Ja  Nein
    Ihre Nachricht erscheint hier

Paraproctitis

  1. 1. Paraproctitis
  2. 2. paraproctitis • (Pararectal abscess) - acute or chronic bacterial inflammation of the peritoneal tissue
  3. 3. etiology • Paraproctitis is one of the most frequent proctologic diseases (20-40% of all diseases of the rectum). Paraproctitis in frequency is the 4th place after hemorrhoids, anal fissures and colitis. Men suffer from paraproctitis more often than women.This ratio ranges from 1.5: 1 to 4.7: 1. Paraproctitis is a disease of adults: there are rare descriptions of fistulas of the rectum in children.
  4. 4. Etiology (flora) • E. coli; • Anaerobes; • Staphylococcus aureus; • White staphylococcus aureus; • streptococcus; • Enterococcus; • Clostridial anaerobes: Cl.perfringens, Cl.Hystoliticum, Cl.oedematiens, Cl.septicum
  5. 5. Pathogenesis. Ways of introduction of infection into pararectal tissue
  6. 6. Columns of Morgagni (columnae Morgani)
  7. 7. • Infection can penetrate through the anal glands, damaged rectum mucosa, hematogenous and lymphogenous pathway, from neighboring organs affected by the inflammatory process. A number of researchers consider paraproctitis a fairly frequent complication of ulcerative colitis and Crohn's disease. Purulent processes in the cells around the rectum are observed in diseases of the prostate gland, urethra, paraurethral, Cooper glands,​​ female sexual organs (perimetritis, bartholinitis), sometimes with osteomyelitis of pelvic bones, spinal tuberculosis.
  8. 8. Typical ways of spreading the inflammatory process • The entrance gates are anal crypts, which open the ducts of the anal glands, or (much less often) the damaged mucosa of the anal canal. • In paraproctitis, fistulous holes are described on the scrotum, thigh, anterior abdominal wall. In addition, it is possible that abscess can break through into the lumen of the intestine at the level of the ampullar part of it and even into the abdominal cavity.
  9. 9. Classification of paraproctitis. The etiological principle distinguishes: Nonspecific paraproctitis, Specific paraproctitis, Post traumatic paraproctitis. By the activity of the inflammatory process: Acute paraproctitis, Recurrent paraproctitis, Chronic paraproctitis (fistulas of the rectum).
  10. 10. Localization of abscesses - Subcutaneous paraproctitis; - Submucosal paraproctitis; - Ischial-rectal paraproctitis; - Behind-rectal paraproctitis; - Pelvic-rectal paraproctitis (pelvio-rectal).
  11. 11. 52% 4% 42% 2% частота различных форм подкожный подслизистый -седалищно прямокишечный -тазово прямокишечный
  12. 12. • 1-subcutaneous; • 2 submucosal; • 3-ischial-rectal; • 4-pelvis and rectum; • 5- behind-rectal.
  13. 13. Retrorectal paraproctitis
  14. 14. clinics • PECULIARITIES OF CLINIC AND PARAPROCTITIS ARE DETERMINED BY LOCALIZATION OF THE FOCUS IN THE CELLULAR SPACES OF THE PELVIS • At the beginning of the disease there is a short period with malaise, weakness and headache. There is an increase in temperature above 37.5 ° C with chill
  15. 15. Subcutaneous paraproctitis
  16. 16. • Submucosal abscess is located under the mucosa of the rectum. Symptoms in this form of location are similar to subcutaneous paraproctitis, however, the pain syndrome and skin changes are less pronounced
  17. 17. • With ischiorectal abscess, a purulent focus is located above the muscle that raises the anus. Because of the deeper location of the abscess, the local symptoms are more vague: blunt pulsating pains in the small pelvis and rectum, intensifying with defecation. Changes from the skin in the form of redness, swelling, swelling, asymmetry of the buttocks occur later on the 5th-6th day from the onset of pain.The general state of health is severe: the temperature can rise to 38 ° C, intoxication is expressed
  18. 18. • The most severe is pelvio-rectal abscess.This is a rare form of acute paraproctitis, when the purulent focus is located above the muscles that form the pelvic floor, a thin layer of the peritoneum separates it from the abdominal cavity. At the beginning of the disease, severe fever, chills, joint pain predominate. Local symptoms: pain in the pelvis and in the lower abdomen. After 10-12 days of pain intensifies, there is a delay of stool and urine
  19. 19. Chronic paraproctitis • Manifested festering fistula.The mouth of the fistulous passage can be located near the anal opening of the rectum or at a distance from it on the buttocks.The pain is usually not expressed. From the mouth of the fistula pus often diffuses feces. During the development of chronic paraproctitis, the opening of the fistula can be closed, pus stagnation occurs, abscesses develop, new tissue defects appear, pus breakthrough and outflow into the rectum and outward, necrosis and other tissue changes that significantly complicate the fistula.Thus, there are complex fistulous systems with branching fistula, cavity depots and a lot of holes.
  20. 20. Factors of chronic course • The internal fistula opening (covered with the epithelial lining of the mouth of an infected one or more anal glands opening in the Morgan crypt) is a source of permanent or periodic infection of the pararectal tissue. • Presence of a formed fistulous course, single or branched, located superficially or deep in the pelvic tissues.The healing is impeded by the epithelialization of the fistula wall, which prevents their collapse and makes the lumen open for reinfection.The internal surface of the fistulous course is lined with granulation tissue or glandular epithelium. • Activation of dormant surgical infection. Infection can stay in the tissues of the body more or less for a long time without causing a disease (latent phase), but then under the influence of various factors manifests itself in the form of acute paraproctitis (active phase). In paraproctitis, the focus of a dormant infection can have a morphological substrate.They are either scars at the site of the open abscess, or the remainder of the fistulous course, or a ligated, undisclosed stitch
  21. 21. Diagnostics • The basis of diagnosis are typical complaints and pains in the area of the rectum and​​ anus.When making a diagnosis, you need a digital rectal examination, sometimes performed under anesthesia in the operating room because of pain. • From laboratory methods, it is necessary to study the blood and urine, blood for glucose, and in case of doubt - ultrasound examination of the perianal region, including using a rectal sensor. In the presence of fistulous strokes, fistulography is shown, the introduction of a contrast medium into the fistula with the execution of a series of X-ray photographs.
  22. 22. treatment • In the very initial stage of the disease, with a small infiltrate in the perianal area, conservative treatment methods are used: sedentary warm baths with potassium permanganate solution, lumbar procaine blockade, warmers, UHF therapy, etc. All thermal procedures are combined with antibiotic therapy.
  23. 23. Operative treatment • Surgical treatment of acute paraproctitis includes early emergency surgical intervention by opening the abscess with removal of pus and necrotic tissues, examination of the abscess cavity with a finger, separation of the bridges and drainage of the cavity.
  24. 24. The choice of method of anesthesia -Infiltration anesthesia (Vishnevsky AS, Ryzhikh AN); - cerebrospinal anesthesia            (Yudin SS); -operational anesthesia (Yakovlev NA, Makhaev NM); -General anesthesia.
  25. 25. The patient's position on the operating table
  26. 26. POSITION ON DEPAGE
  27. 27. Radical operations in acute paraproctitis can be grouped as follows • 1. opening and draining of the abscess, excision of the affected crypt and dissection of the purulent course into the lumen of the intestine; • 2. opening and draining of the abscess, excision of the affected crypt and sphincterotomy; • 3. dissection and drainage of the abscess, excision of the affected crypt, ligation; • 4. dissection and drainage of the abscess, delayed excision of the affected crypt and movement of the gut flap to interrupt the infection pathway from the lumen of the rectum
  28. 28. • Apply radial, semilunar, crosswise incisions, the most convenient of them - semilunar and radial.They provide a gaping wound and an outflow of purulent exudate, as well as less traumatic. Strict bed rest is necessary. • When putrefied necrotic paraproctitis during the operation, complete excision of dead fiber is performed within healthy tissues, and two or three additional cuts of the skin and subcutaneous tissue for draining are performed.
  29. 29. The incisions used in acute paraproctitis: 1 - perianal abscess; 2 - behind-mousse; 3 - Ischiorectal.
  30. 30. • Surgical approaches used for ischiorectal (1) and pelviorectal (2) abscesses.
  31. 31. DISSECTION with subcutaneous paraproctitis
  32. 32. With subcutaneous-submucosal paraproctitis, the incision is made in the radial direction through an interested crypt.
  33. 33. With ischial-rectal paraproctitis, a radial incision can not be opened, it is dangerous to damage the sphincter.
  34. 34. INCISION of the retrectectal paraproctitis
  35. 35. REASSESSMENT of abscess cavity
  36. 36. Complications of paraproctitis Purulent fusion of the rectum wall with the spread of intestinal contents into the pararectal tissue.Widespread access to pararectal tissue for the contents of the intestine can lead to even more severe consequences as follows: • Formation of purulent fistula between the rectum and the vagina • Purulent melting of the urethra, the transition of the purulent process to the scrotum followed by gangrene • Breakdown of pus into the free Abdominal cavity and retroperitoneal tissue with the development of peritonitis and retroperitoneal phlegmon, which lead to sepsis and death.? Necrosis of the skin in the area of dissemination of the abscess​​
  37. 37. Complications of acute paraproctitis
  38. 38. Prevention of recurrence of the disease • To achieve a lasting effect, in addition to the radical surgery performed, it is necessary to adhere to a number of rules. • • Fighting with constipation. It is necessary to achieve a regular soft stool. • The diet should contain plant foods rich in fiber (fresh fruit vegetables, especially beets, cabbage), and fermented milk products (kefir, curdled milk, cottage cheese).You should avoid a dough product. • In diabetes, the normal blood sugar level should be maintained, otherwise purulent diseases can not be avoided • Maintaining normal body weight • Observance of personal hygiene rules - regular washing after stools • Treatment of chronic hemorrhoids And anal fissures.

×