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Hemorrhoids are one of the most
common diseases. Word «hemorrhoid»
translated from Greek language means
«bleeding», which directly connected
with the most prevalent symptom of this
disease – there is blood outflow from
anus. Hemorrhoids are equally common
among male and female. Frequently
females mark acute haemorrhoidal
thrombosis; usually it happens during
third trimester of pregnancy    
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Anorectal abscess signifies
inflammation of the fat in one of the
spaces surrounding the anorectum.
Infection from rectum by anal glands,
which are situated in anal crypts of the
anal canal penetrate perianal tissue.
Crypt abscess always is at the level of
the dentate line. The reasons of crypt
abscess are different: constipation,
hemorrhoids, anal fissure ecc. Anal
gland infection is also the principal
cause of anal fistulas.  
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Anal fissure is a spontaneously
appeared linear tear (ulcer) in the anal
mucosa. Anal fissure is quite common.
Among proctology disease this is one
of three the most frequent (11%-15%
or 20-23 cases amongst 1000 people).
Anal fissures are more prevalent
among young and middle- age females.    
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 Constipation.   Now constipation is
one of the most common conditions that
bring a patient to see a physician in al
the world.  For example, 2.5 million
people with constipation (1.2% in the
general population) visit each year
doctors and even more numbers try
to solve this problem by themselves
using laxatives. What is constipation?
Constipation is not separate disease.
There is symptom of many illness.  
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.
Ulcerative colitis is chronic recurrent
bowel disease, which is based on
manifest diffuse non-specific
inflammation of the mucosa of the
rectum and colon.
Read_______

Cron`s colitis is chronic, recurrent,
inflammatory disease of unknown
etiology that affects the gastrointestinal
tract This disease is characterized by
skip lesion and transmural inflammation,
and it can be affect any segment of the
gastrointestinal tract. This illness also
has tendency to early, local and system
complications.   
Read_______

Polyps and polyposis syndromes.
The definition of polyp is not clear at all.
Presently, only epithelial glands
excrescence, which rises above mucosa,
is called true polyp.   
 Read_______

 
Rectal cancer. These days rectal
cancer without exaggeration is the
problem of global degree.   
Read_______

Colon cancer.  Measurement of (CEA)
carcinoembryonic antigen, which was
found in embryonic cellules of
gastrointestinal tract, is another
direction in the early detection of colon
and rectal cancer.
Read_______
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Home >>Diseases >> Anorectal abscess, Anal fistula


Anorectal abscess.

Anorectal abscess signifies inflammation of the fat in one of the spaces surrounding the anorectum. Infections from rectum by
anal glands, which are situated in anal crypts of the anal canal, penetrate perianal tissue. Crypt abscess always is at the level
of the dentate line.
The reasons of crypt abscess are different: constipation, hemorrhoids, anal fissure ecc.
Anal gland infection is also the principal cause of anal fistulas. Classification of anorectal abscess is based on involved fat space.
There are perianal abscess, ischiorectal abscess, supralevator abscess, postanal abscess, horseshoe abscess (anterior and
posterior).

Clinical feature of anorectal abscess.   
There are cardinal clinical signs of anorectal abscess: swelling, redness, pain of perianal region, difficulty in sitting, walking and
painful defecation (not always). Fluctuation in the center of redness can also occur. Subsequently, patient’s condition worsen,
they get fever, especially, in deep abscess case (ischiorectal, supralevator abscesses). In some cases (superficial localization)
patients condition doesn’t change. Abscess localization and internal opening are identified by digital examination, anoscopy,
rectosropy, intrarectal ultrasound examination, dyestuff test.

Inspection of perianal area allows to fine local symptoms (redness, swelling, local warmth). Next examination is digital
(important for deep abscesses). Next step is puncture and painting over the abscess that allows identifying internal opening.
Anorectal abscess is treated only by operation. There are two types of operations: radical (with primary fistulotomy) and
symptomatic (incision and drainage without fistulotomy). Radical operation is possible only in proctology department.
In surgical department perianal abscesses usually are managed symptomatically and after this treatment patients have quite
high risk of development persistent fistula. Surgical treatment also can be performed in one phase (with primary fistulotomy)
and in two phases (if fistula can not be identified right away, first surgeon realizes incision and drainage and in several days he
detects fistula and makes fistulotomy).  
 
If abscess bursts itself or is inserted by surgeon (without fistulotomy) usually anal in some period anal fistula appears.
Internal opening in anal canal doesn’t heal over and there is the reason of chronic anal fissure (70% of clinical cases of
anorectal abscess). External opening can appear in other area. Infection persists because of high-virulent microorganisms,
which come through internal opening from rectum. In this case some period after incision patients feel well (without any
discomfort).
There are two types of fistula:
1. Complete anal fistula (such fistula has internal opening, which is localized
in one of the anal crypts, and external opening in perianal area)  
2. Incomplete anal fistula (which has only internal opening)        

Fistulas also can be simple and difficult. Scar tissue in crypt’s area, two and
more external openings, presence of abscesses is the features of difficult
fistula.

Defining the trajectory of the fistula in relation to the external sphincter
establishes to the following classification
- Intershincteric fistula
- Trans-sphincteric fistula (which passes throw through the external
 sphincter)
- Suprasphincteric fistula is the most difficult and passes out of external
 sphincter

Intershincteric fistula is the simplest type of fistula. Usually, the trajectory
of such fistula is straight, and scar tissue is not manifest. The disease is not
long standing. The external opening is close to the anal verge. Internal
openings can be located at any of anal glands, on dentate line level.
Trans-sphincteric fistula is more common than extrasphincteric but can be low and high (can passes through deep, subcutaneous
or superficial part of external sphincter).
Suprasphincteric fistula can be different complexity.
The first level of complexity means that fistula has small
internal opening without scar, abscesses or indurations in
fat and its trajectory is quite straight.

The second level of complexity means that scar around I
nternal opening is evident but patient has no abscess or
indurations in fat.

The third level of complexity. Internal opening is small,
without scar, but there are some abscesses or indurations
in fat.

The forth level of complexity. Internal opening is large,
with scar around, there are some abscesses or indurations
in fat.
Internal openings    Anal fistula
Clinical features of anal fistula. Usually, patients with anal fistula have some discomfort in perianal area. First of all, because
of wound (external opening) in the skin close to anus and also because of pus or blood outflows from this wound. Patients have
to wash this region very often or makes sits bath. Sometimes they have itch. Patients rarely have any pain that is typical only
for incomplete anal fistula (pain increases during defecation and slowly increases in several minutes).              
Patients feel quite well up to next abscesses (which appears in some weeks month or even years). If perianal abscess again is
managed by incision and drainage without fistulotomy patient feels well in some days, but wound in perianal skin (smaller than
1cm) doesn’t heal over completely. There is external opening with permanent pus outflow. Sometimes patient can see blood that
is draining from this wound. It can be the sign of malignant fistula.
In periods of remission the pain is not characteristic feature of anal fistula. Patient is in satisfactory condition. If patient to use
hygienic procedures thoroughly, he can not so suffer from anal fistula for a long time. Appearance of new focuses of
inflammation, drawing external sphincter  into this process is  a cause of new symptoms of  disease appear: headache, sleep
disturbance, performance decrement, low sexual potency, mental disturbance.

Complications of anal fistula
1. Fecal incontinence, due to difficult local changes with deformation of anal canal and perineum, scar process in muscular
tissue of external sphincter.
2. Anal stricture of anal canal, due to scar laxity.
3. Malignant fistula (usually when fistula exists more than 5 years)

Diagnosis of anal fistula is based on typical examinations: inspection of perianal area (there is wound in skin close to anus),
digital examination (is necessary to fine internal opening). Other examinations (probe, examination with brilliant green solution,
intrarectal ultrasound) are necessary to identify the type of fistula.
Differential diagnosis of anal fistula includes Crohn’s disease, pilonidal sinus, tuberculosis, actinimycosis.   

Read also Treatment of anal fistula
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