Fistula of the rectum
Fistula of the rectum is a stroke thatis located under the skin in the anal area. He connects the affected anal gland and the skin near the anus. The causes of the development of a chronic inflammatory process that leads to fistula formation can be surgical intervention, rectal resection, trauma, cracks in this area and in 95% of cases - acute paraproctitis.
Not every patient with acute paraproctitisdeveloping a fistula of the rectum. But if the abscess is opened, drained, but not completely removed by the outer gate to infect the infection, this will result in the purulent contents constantly entering the lumen of the fistula. All this will lead to the formation of infiltrates and cavities with pus, the outer walls of the fistulous course begin to sclerosis, and the inner walls are covered with a granulation tissue.
At first the inflamed gland swells, formingpus looks for an exit through loose fiber into the rectum and through the skin outward in the area of the anal opening. Thus, an internal and external opening of the fistulous course is formed. Clinically distinguish:
- complete (external) fistula accompanied by constant burning, suturing and pus during exacerbation and a sense of discomfort, inconvenience in defecation due to thickening of the skin during remission;
- incomplete (internal) fistula of the rectum, symptomswhich is such that during the period of remission, he does not cause discomfort and almost does not manifest himself, but when the condition worsens, the patient's condition deteriorates sharply.
The disease proceeds undulating. An exacerbation is observed when the passages are blocked, when the patient is concerned about the pain in the anus, which is aggravated by defecation. The patient's fever, headache, sleep and potency suffer, the syphilis and periodic purulent discharge disturb. There is a strong skin irritation, burning and itching, so the patient needs frequent washing and a change of gaskets.
After opening the cavities,improves, inflammation decreases, secretions become rare, work capacity is restored. Prolonged inflammatory processes in the pararectal tissue lead to complications of the fistula. There may come a deformation of the anal canal and a scar of sphincter muscles that disrupt normal functioning and lead to incontinence of the anal sphincter. In the most difficult and severe cases, malignant degeneration of the fistula can occur.
The diagnosis "fistula of a rectum" puts the proctologist -a specialist who conducts the patient a rectal finger examination in an armchair in an outpatient setting. After a certain preparation of the patient, the endoscopic examination of the large intestine is carried out to rectify the diagnosis - a sigmoidoscopy. In this case, you can visually see the mucosa, take the tissue on a biopsy, make a differential diagnosis if you suspect a tumor.
If necessary, the sounding of the externalfistula, and to clarify the location of the fistula site, ultrasound is performed - ultrasonography. To determine the direction of the strokes, localization of internal fistulas is necessarily performed by fistulography. These studies help confirm that the patient has a fistula of the rectum, or to exclude this diagnosis.
Conservative treatment is ineffective andIt is used as a prophylaxis for relapse in the postoperative period. Operative intervention is performed by specialists in a hospital, under general anesthesia or under epidural anesthesia. The type of operation depends on the location of the fistula in relation to the sphincter, the degree of scar tissue, the presence and quantity of purulent cavities in the cellulose. But in any case, when a patient has a fistula of the rectum, the operation is inevitable.
The most favorable is postoperativeperiod with intrasfincter fistulae. It is most difficult to technically carry out the operation for trans-finctic and extra-inflexional cases. It is especially difficult for complex branching of the passages, when it is necessary to completely excise the tissues that participate in fistula formation and maximize the function of the sphincter.
In the postoperative period, the patient must make bandages with levomycol, baths with potassium permanganate, later with chamomile or calendula. The process of complete healing lasts about a month.
