Features of diagnostics and surgical treatment of acute anaerobic paraproctitis
Abstract
Aim of investigation. To develop medical approach at acute anaerobic paraproctitis (AAP).
Materials and methods. In 1997–2006 in urgent proctology department The SSC of coloproctology 4046 patients with various types of acute paraproctitis were operated. Original study included 140 patients, 20 to 86 years old (mean age made 57,1±3,9 years) with anaerobic paraproctitis. Investigation included general physical examination, digital examination of the rectum and rectoromanoscopy, transabdominal and transrectal ultrasound, bacteriological study of wound exudate and morphological study of affected pararectal fat. Ultrasound investigation was supplemented by computer tomography for differential diagnostics. Surgical interventions in all cases was carried out under urgent indications. Severity of patients state and efficacy of treatment was evaluated by SAPS and SOFА scoring systems.
Results. Three clinical forms of AAP were defined: fulminant, acute and subacute. In relation to etiological agent type following forms of anaerobic paraproctitis were determined: clostridial, non-clostridial and purulent. Forty-five percent of patients admitted in severe and extremely severe state, 25,7% addressed for medical care 7 days and later after onset of disease. Mortality was 15,7% – all of the were patients, that admitted in extremely severe state. Extrasphincter fistulas were formed in 11 (10,8%) patients.
Conclusion. The success of treatment of patients with AАП in many respects depends on early diagnostics of inflammatory process, early urgent surgery with essential and extensive enough necretomy and adequate intensive care.
References
1. Ан В.К., Ривкин В.Л. Неотложная проктология. – М.: Медпрактика-М, 2003. – 144 с.
2. Белоцкий С.М. Факторы естественной резистентности при инфекции: Руководство // Иммунология инфекционного процесса. – М., 1994. – 72 с.
3. Карлов В.А., Белоцкий С.М. Иммунокоррекция в интенсивной терапии хирургического сепсиса. Раны и раневая инфекция: Материалы междунар. конф., ноябрь 1998 г. – М.: Ин-т хир. им. А.А. Вишневского, 1998. – С. 163.
4. Коплатадзе А.М. Анаэробный парапроктит // Хирургия. – 1994. – № 10. – C. 12–15.
5. Основы колопроктологии / Под ред. Г.И. Воробьёва. – М., 2006. – 432 с.
6. Тимербулатов В.М. Анаэробный парапроктит. – Уфа, 1988.
7. Abcarian H., Eftaiha M. Floating free-standing anus: a complication of massive anorectal infection // Dis. Colon Rectum. – 1983. – Vol. 26. – P. 516–521.
8. Abdulla A., Yee L. The clinical spectrum of Clostridium sordellii bacteraemia: two case reports and a review of the literature // J. Clin. Pathol. – 2000. – Vol. 53. – P. 709–712.
9. Brook I. Microbiology and management of soft tissue and muscle infections // Int. J. Surg. – 2008. – Vol. 6, N 4. – P. 328–38.
10. Corman M.L. Colon and rectal surgery. – 5th ed. – Baltimore: Lippincott Williams & Wilkins, 2005.
11. Eke N. Fournier’s gangrene: a review of 1726 cases // Br. J. Surg. – 2000. – Vol. 87. – P. 718–728.
12. Gordon P.H. Principles and practice of surgery for the colon, rectum, and anus / Eds. P.H. Gordon, S. Nivatvongs. – 3rd ed. – N.-Y., 2007. – 1354 p.
13. Korkut M., Icoz G., Dayangac M. et al. Outcome analysis in patients with Fournier’s gangrene: report of 45 cases // Dis. Colon Rectum. – 2003. – Vol. 46. – P. 649–652.
14. Maier A.G., Funovics M.A., Kreuzer S.H. et al. Evaluation of perianal sepsis: comparison of anal endosonography and magnetic resonance imaging // J. Magn. Reson. Imaging. – 2001. – Vol. 14. – P. 254–260.
15. Munoz-Villasmil J., Sands L., Hellinga M.I. Management of perianal sepsis in immunosuppressed patients // Am. Surg. – 2001. – Vol. 67. – P. 484–486.
16. Williamson M., Thomas A., Webster D.J.T., Young H.L. Management of synergistic bacterial gangrene in severely immunocompromised patients. Report of four cases // Dis. Colon Rectum. – 1993. – Vol. 36. – P. 862–865.
17. Wolff B.G. The ASCRS textbook of colon and rectal surgery. – Springer Science + Business Media, LLC. – 2007.
Review
For citations:
Bolkvadze E.E. Features of diagnostics and surgical treatment of acute anaerobic paraproctitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2009;19(3):63-69. (In Russ.)
Views:
7
Email this article 
