Chronic paraproctitis (pararectal fistula). It constantly hurts and itches in the anus: get acquainted - anal fissure Mkb 10 adrectal fistula

anorectal abscess. Cryptoglandular abscess.

ICD-10 CODE

K61. Abscess of the anus and rectum.

CLINICAL PICTURE

During the transition to the chronic stage, paraproctitis in children proceeds according to fistulous and non-fistulous variants.

The fistulous variant makes up 95% of cases. It is rarely found in the "classic" form, which is characterized by an internal opening in the intestine, a fistulous tract with more or less pronounced cicatricial changes in the fiber, and an external opening on the skin of the perineum (Fig. 28-11). This nature of the fistula is found only in older children, and in infants the external opening as such is usually absent. After the maturation phase, lasting up to 3-4 weeks, after the opening of the pararectal abscess, the maturity phase begins. In this case, the fistula is formed on the basis of an already existing communication with the rectum, and an abscess is an intermediate stage in its formation. There is every reason to believe that a certain proportion of fistulas of this kind has a congenital basis. At the very beginning of the postnatal period, some of them for a short time have the form of incomplete internal ones (opening only into the intestinal lumen) without clinical manifestations, but then, due to inflammation, they turn into complete ones, sometimes located symmetrically.

Rice. 28-11. Chronic paraproctitis with multiple simple fistulas in an infant.

Symptoms are characterized by periodic and strictly local exacerbations of the inflammatory process. In place of the pre-existing external opening, a small amount of purulent fluid accumulates, covered with a thin epidermal film. This film is easily destroyed, a drop or two of pus comes out, and then a scanty serous-purulent discharge comes out through the fistulous opening for several days. Soreness and hyperemia around the fistula opening are moderate. After a short period of time, the fistula closes again. The intervals between such "exacerbations" can last from several weeks to several months and even years. The general condition of the child is satisfactory. Attention is drawn to the fact that, despite repeated exacerbations, the emergence of new fistulous passages-branching or new external fistulous openings does not occur, sometimes after a series of relapses, the fistula does not make itself felt for a long time. Apparently, the internal opening of the fistula is practically obliterated or has microscopic dimensions, so reinfection through it is minimal.

anorectal abscess. Cryptoglandular abscess.

ICD-10 CODE

K61. Abscess of the anus and rectum.

CLINICAL PICTURE

During the transition to the chronic stage, paraproctitis in children proceeds according to fistulous and non-fistulous variants.

Rice. 28-11. Chronic paraproctitis with multiple simple fistulas in an infant.

An anal fissure is thought to develop due to damage to the anal canal by hard or profuse stools, with the development of a secondary infection. Trauma (eg, anal sex) is a rare cause. An anal fissure can cause a spasm of the internal sphincter, which in turn disrupts the blood supply and creates conditions for a chronic course.

Anal fissure - a defect in the wall of the anal canal of a linear or triangular shape with a length of 1 to 1.5 cm, located near the transitional fold above the Hilton line. The origin of the crack is associated with many reasons, but the most important factor is the trauma of the mucous membrane of the anal canal with feces, foreign bodies, and damage during childbirth. A predisposing moment may be hemorrhoids. An acute anal fissure has a slit-like shape, smooth even edges, its bottom is the muscle tissue of the sphincter.

With a long course of the pathological process, the connective tissue grows along the edges of the crack, its bottom is covered with granulations and fibrous plaque. In the region of the outer edge of the crack, excess tissue forms an anal (sentinel) tubercle. Thus, an acute anal fissure turns into a chronic one, which is essentially an ulcer with cicatricial edges and a scar bottom. Sometimes an acute anal fissure disappears on its own, but most often it becomes chronic. As a rule, there is only one crack, and most often it is located on the back, closer to the coccyx, wall of the anal canal. Occasionally, 2 cracks appear on the back and front walls, which are one above the other. True cracks should be distinguished from various superficial lesions of the perianal skin.

Quite common in proctology. The pathology is quite severe and requires prompt treatment, usually surgical. It is important for specialists to know the ICD 10 paraproctitis code, this allows you to accurately determine the form of the disease, to establish the most correct treatment tactics.

Acute and chronic forms are in different sections, as discussed in more detail below.

Pathology is an inflammatory process in pararectal tissue(it surrounds the rectum). The main causes of the disease are non-compliance with the rules of personal hygiene, injuries in the anus, leading to infection of this area. The presence of diseases of the rectum (,) matters, they can provoke chronic paraproctitis, which leads to the formation.

The cause of the pathology can be any source of chronic infection in the body, especially in cases of weakening of the human defenses (observed in the presence of severe concomitant diseases).

Paraproctitis is manifested by a pronounced pain syndrome in the perineal region, which intensifies when trying to carry out an act of defecation. This leads to the emergence of

On palpation of the inflammation zone, patients notice a sharp pain, it is possible to determine the boundaries of the accumulation of purulent contents.

The general condition of patients is also deteriorating - the body temperature rises, there will be complaints of weakness, apathy, dizziness. There are dyspeptic phenomena in such patients - nausea, vomiting, lack of appetite.

With the progression of the disease, it may result in the formation of a fistula. A channel with purulent contents is formed, which connects the intestinal cavity with the environment. In such situations, more serious and extensive surgical intervention is required for treatment.

Classification of paraproctitis according to ICD 10

The following sections are distinguished in the international classification of diseases.

ICD code 10 for acute paraproctitis - K 61.0. Name - anal abscess. Depending on the location of the pathological formation in this zone, it is divided into rectal (K 61.1), anorectal (K 61.2), ischiorectal (K 61.3) and intrasphincteric (K 61.4).

The first subspecies is characterized by the fact that the abscess is located in the rectum, the second - around the anus. If an abscess forms in the ischiorectal fossa, this is the ischiorectal form of the disease.

In the case of finding a pathological formation directly on the anus, an intrasphincteric abscess is exposed.

The clinical picture of acute paraproctitis is described above. General intoxication phenomena are more pronounced than in the chronic form of the disease.

Some clinicians use the name . With any acute inflammation of this zone, the formation of a pathological secretion occurs. Therefore, the ICD code 10 of purulent paraproctitis is K 61.0. Patients should be aware that these forms of the disease are identical to each other.

In cases where the disease is not treated, the inflammatory process is delayed and becomes chronic.. Such situations are characterized by the formation of a fistulous canal between the rectum and the external environment.

Patients will complain of a purulent discharge that constantly stains underwear, causing discomfort. The pain syndrome is not pronounced, worries during periods of exacerbation. The general condition of patients is better than in the acute form of the disease, no pronounced intoxication is observed.. But gradually, patients become irritable, it is difficult for such patients to concentrate, their performance decreases.

ICD code 10 for chronic paraproctitis - K 60.3. It is called fistula of the anus and belongs to the heading K 60.0 - fissure and fistula of the anus and rectum.

Other codes related to chronic paraproctitis in the international classification are as follows: K 60.4 (rectal fistula) and K 60.5 (anorectal fistula). The first implies the formation of a pathological canal only within the anus, the second - between the intestinal cavity and the anus.

Conclusion

Paraproctitis is one of the unpleasant diseases in proctology, acute and chronic forms equally adversely affect the body. The symptomatology of the inflammatory process of the pelvic floor tissue causes serious discomfort for patients, especially in the case of the formation of a fistulous canal.

Patients need to see a doctor on time. Specialists need to correctly determine the type of pathology for the correct path of treatment. To this end, it is imperative to have an idea of the position of the disease in the international classification of diseases.

According to statistics, among all proctological pathologies, paraproctitis ranks 4th in terms of prevalence. Often the disease is diagnosed in men.

Paraproctitis (ICD-10 code - K61) refers to an acute or chronic inflammatory process occurring in the adipose tissue surrounding the rectum. Often, the pathology is accompanied by the flow of hemorrhoids and occurs when pathogens penetrate through the affected skin of the anal area. If signs of the disease appear, it is imperative to consult a doctor for diagnosis and subsequent treatment.

Classification

According to the classification, paraproctitis is divided into several types according to the form of the course, the cause of the occurrence, and the localization of the lesion. Depending on the course of the disease, it can be acute or chronic. Regardless of the classification of acute paraproctitis, it is a character that was formed in the patient for the first time. In turn, doctors distinguish several different forms of this disease. According to the classification of paraproctitis by localization, doctors distinguish such types as:

rectal;
submucosal;
subcutaneous;
ischiorectal;
necrotic;
pelviorectal.

All these forms have their own specific manifestations, which must be taken into account when making a diagnosis. For subcutaneous paraproctitis, the photo of which demonstrates the peculiarity of the course of the pathology, the presence of purulent inflammation of the subcutaneous tissue of the perianal region is characteristic, which, with timely treatment, has a favorable prognosis.

With ischiorectal paraproctitis, a purulent-inflammatory process occurs in the rectal fossa. The submucosal form is characterized by the fact that inflammation occurs in the submucosal layer of the rectal canal. In the pelviorectal type of the disease, the area of purulent lesion is localized inside the small pelvis.

The acute necrotic form is considered one of the most severe, as it provokes significant necrotic tissue damage and is characterized by a lightning-fast course. According to the classification of paraproctitis, according to etiology, such types are distinguished as:

specific;
non-specific;
anaerobic;
traumatic.

The chronic type of pathology is characterized by the fact that inflammation affects almost all the pararectal space and surrounding tissues. The disease is characterized by a prolonged course with periods of exacerbation and remission, resulting in the formation of fistulas. The chronic form always develops against the background of an acute lesion with improper or inadequate treatment.

As a result, fistulas are formed that do not heal for a very long time and unite the cavity of the pararectal abscess with other organs or open outwards. According to the classification of chronic paraproctitis, complete and incomplete types are distinguished, as well as internal or external fistulas. In addition, they may differ in location. In addition, there are various types of paraproctitis, which are divided according to how exactly they are located in relation to the sphincter. That is why, such fistulas are distinguished as:

extrasphincteric;
intrasphincteric;
transsphincteric.

According to doctors, the most common cause of the chronic form of the disease is improper treatment and late visits to the doctor. That is why, if you have symptoms of the disease, you should immediately consult a doctor for treatment.

Causes

The main cause of the disease are pathogens that penetrate from the rectum. Any household injuries, wounds, as well as surgery on the mucosa can provoke an infection. In addition, bacteria can penetrate through sinusitis, caries. With the flow of lymph and blood, pathogens from the area of inflammation are carried to other tissues and organs.

Another way bacteria can enter is by blocking the duct of the anal gland. Regardless of the type of paraproctitis, such factors as malnutrition, the presence of inflammatory processes, and a sedentary lifestyle contribute to the formation of the disease. Additional contributing factors include:

diabetes;
weakened immunity;
anal intercourse;
vascular atherosclerosis;
cracks in the anal area.

In especially severe cases, inflammation covers several areas located near the intestine at once.

Main symptoms

The acute form of the disease is characterized by a sudden onset and intensity of manifestation. The external symptoms of paraproctitis (photos on this topic are presented in the article) largely depend on the location of the pathology, the area of the lesion, the characteristics of the pathogen, as well as the body's ability to resist. Some common clinical manifestations are observed in all types of this disease. These include such as:

symptoms of poisoning;
hyperemia and fever;
problems with bowel movements;
soreness in the anus.

Each of the forms of damage is characterized by certain signs. With subcutaneous paraproctitis, the symptoms, the photo of which allows you to determine the peculiarity of inflammation, are expressed in the form of severe reddening of the skin, tissue thickening, swelling, pain on palpation, and also the inability to sit normally. The affected area immediately changes, which makes the patient immediately contact the doctor.

The symptoms of the ileo-rectal form are also non-specific, and only after a week of the course of the disease one can notice such signs as:

puffiness;
skin redness;
asymmetry of the buttocks.

Chronic paraproctitis (we cannot provide a photo for aesthetic reasons) is characterized by the formation of a fistula. It is a kind of formation with a channel that goes out. Through the abscess, located at the purulent contents are released. With a complicated course of pathology, additional formations are formed.

Disease in children and pregnant women

Children are also periodically diagnosed with paraproctitis, however, it is not always possible to recognize the course of the pathology in a timely manner. It is worth noting that this disease occurs mainly due to microtrauma, stagnation of feces, as well as blockage with a viscous secret. Since the classification of paraproctitis is quite extensive, it is imperative to conduct a diagnosis in order to exclude the presence of a perineal abscess.

Among the main signs, it is necessary to highlight anxiety and causeless crying, fever, the presence of compaction and redness near the anus. In the case of fistula formation, purulent discharge is possible.

In some cases, the formation of paraproctitis in pregnant women is possible, which can have a very bad effect on the condition of the fetus, especially if there is a purulent formation in the first trimester of pregnancy. When the very first signs appear, you need to consult a doctor who will determine the tactics of pregnancy management and treatment.

It is imperative to understand what kind of classification, clinic, diagnosis and treatment of paraproctitis exist in order to prevent the development of dangerous complications. Diagnosis of the disease implies:

collection of complaints;
examination of the rectal region and perineum;
palpation of the abscess area;
examination of the anus;
laboratory research;
fistula probing;
tomography;
fistulography;
ultrasonography.

For an experienced specialist to accurately make the correct diagnosis, it will be enough to collect an anamnesis and existing complaints. However, in complex cases, additional diagnostic methods are required. Often it is necessary to differentiate paraproctitis from other diseases, since at the beginning of the course, it does not have any characteristic signs.

Features of treatment

Regardless of the classification of paraproctitis, treatment mainly involves an operation. To do this, the doctor performs an autopsy of a purulent formation, its drainage and removal. Only this will achieve a complete cure.

The chronic form is mainly treated conservatively if there is an exacerbation of the inflammatory process. This is done in order to eliminate the abscess. The patient is also prescribed antibiotics and physiotherapy. Full recovery occurs after about 5 weeks, subject to strict adherence to all doctor's recommendations.

Medical treatment

An obligatory step in the treatment of paraproctitis is the use of antibiotics. They can be used systemically and locally. In the acute course of the disease, antibacterial treatment can be prescribed after paraproctitis, as this will prevent the development of complications after surgery. In the chronic course of the disease, antibiotics can be prescribed during the preoperative preparation and in the postoperative period.

Among the main drugs that are used for treatment, we can distinguish "Gentamicin", "Cefotaxime", "Metronidazole". It should be noted that systemic antibacterial drugs are not used to treat all patients. Similar products can also be used as powders, ointments and creams. Topical application of antibacterial agents helps speed up the healing process and prevent the occurrence of infectious complications. Often prescribed drugs such as "Levomekol" or "Levosin". These drugs are applied directly to the wound, previously treated with an antiseptic 2 times a day. From above you need to cover the wound with a gauze bandage.

Surgery

When treating paraproctitis, surgery is considered the main method. During the surgical intervention under epidural anesthesia or general anesthesia, the doctor opens the abscess, carries out the subsequent drainage of this area, and then the detection of the fistulous tract and the affected crypt, as well as their elimination.

The operation is performed in a specialized medical institution, and this procedure requires a highly qualified surgeon, extensive experience and good knowledge of anatomy.

Physiotherapy

Physiotherapeutic techniques are widely used in the acute form of the disease in the postoperative period, as well as in the chronic course of the disease. Physiotherapeutic techniques can be used in preparation for surgery to reduce the inflammatory process, the destruction of pathogens. The most effective methods of physiotherapy are such as:

ultraviolet irradiation in the affected area;
electrophoresis;
magnetotherapy;
electrophoresis;
irradiation with infrared rays.

When carrying out physiotherapeutic treatment of paraproctitis, patient reviews are very good, since such techniques help to eliminate existing violations very quickly.

You can treat paraproctitis at home with the help of folk remedies. However, it is worth remembering that an operation is required first, as this is a surgical pathology. Folk remedies can be used as an addition to the main treatment. In addition, you must first consult with your doctor.

You can stop inflammation with the help of such means as:

juice or infusion of red rowan berries;
infusion of yarrow, sage and chamomile;
herbal teas;
tincture of calendula;
baths with sea salt.

Juice or infusion of red rowan should be taken daily 3 times a day before eating. Red rowan has pronounced anti-inflammatory properties, and also has a carrying, antimicrobial and anti-inflammatory effect.

On the external exit of the fistula, you can apply tincture of calendula for disinfection. Mummy baths also have a good effect. To prepare them, you need to dissolve the mummy tablets in hot water, and when the solution reaches room temperature, pour into a wide basin and sit in it. In addition, rectal suppositories made from raw potatoes can be used for treatment. From a vegetable, you need to cut a cylinder as thick as a little finger, lubricate it with petroleum jelly and insert it into the anus overnight. This remedy helps reduce pain and inflammation.

Dieting

There is no special diet for patients suffering from paraproctitis. During the course of the disease, experts recommend adhering to fractional nutrition. You need to eat in small portions 4-5 times a day. Soups must be present in the diet. Dinner should be light and be sure to consist of any dairy products or fresh vegetables.

Fatty varieties of fish, poultry and meat, as well as spicy and fried foods, should be excluded from the usual diet, as well as limiting the consumption of alcohol, white bread, and muffins. Cooking should be done using gentle heat treatment. It is also important to maintain a full water balance in the body, that is, consume at least 1.5 liters of water per day.

Recovery period

After the operation to remove paraproctitis, patients must comply with the regimen. For 3 days you need to consume plenty of fluids, after which a strict diet is prescribed. Fatty, fried, salty, sour foods must be excluded from the usual diet.

Very important is the postoperative period, which lasts for at least 3 weeks. During all this time, it is imperative to carefully monitor the perineum and postoperative wound. Be sure to prescribe antibacterial agents for systemic use. It also shows the wound dressing with the use of antiseptic solutions, ointments. Help in the treatment is also a means to improve healing.

Possible Complications

Acute paraproctitis can be very dangerous for its complications, among which are the following:

melting of the urethra, vagina and other organs with pus;
necrotic damage to the walls of the rectum;
leakage of feces into pararectal tissue;
purulent inflammation of the peritoneum;
formation of a retroperitoneal abscess.

All these complications can lead to the fact that the disease can turn into sepsis, when pathogens enter the bloodstream and can even lead to the death of the patient. In addition, there are a number of pathological conditions that are formed against the background of the chronic form of paraproctitis, in particular, such as:

the formation of scar tissue;
deformation of the rectal canal;
leakage of feces from the anus;
weakness of the anal sphincter;
rectal stricture.

Chronic fistulas are covered from the inside with epithelium, the cells of which, with a prolonged course of pathological processes, can degenerate into a malignant form. The risk of cancer is another good reason to immediately seek medical help when the first signs of the disease appear.

Prevention and prognosis

Doctors distinguish between primary and secondary prevention of the disease. The primary one implies strengthening the immune system, saturating the body with vitamins, and following the rules of nutrition. In addition, it is very important to lead an active lifestyle, normalize weight and timely treat diseases that can provoke the development of paraproctitis.

Secondary prevention implies a set of measures that will help prevent the recurrence of the disease after surgery. For this it is shown:

prevention of constipation and their rapid elimination;
weight control;
dieting;
personal hygiene;
treatment of foci of chronic infection.

Timely access to the doctor and strict implementation of all his prescriptions is the only prevention of the onset of a chronic form of the disease.

With a timely visit to the doctor, the prognosis after treatment of paraproctitis is quite favorable. However, patients who turned to the doctor too late or self-medicated are threatened not only with the transition of the disease to a chronic form, but also provoke the death of the patient. The chronic form of the disease in the absence of timely treatment can lead to the formation of fistulas, as well as go to the malignant stage.