Paraproctitis in children under one year of age, treatment reviews. How paraproctitis manifests itself in young children under one year old

Paraproctitis is purulent inflammation fatty tissue located around the rectum and anus.

Paraproctitis occurs quite often in infants. Most often it occurs in male infants under 1 year of age, but this problem can also occur in girls at any age. Doctors use different approaches to treating this disease depending on the age of the patient.

The occurrence of the disease is influenced by infection, which is characterized by the accumulation of pus. Purulent masses collect under the skin within the soft tissues of the anus.

The mechanism of the disease, classification, causal series, features of symptoms
This sore spot often looks like a red boil. As the situation worsens and the accumulation of pus increases, the inflammatory element will grow and become more and more painful.

Some of them rupture and the pus comes out spontaneously; in others, surgery may be required, during which doctors will open the abscess and remove the pus.

Some of these inflammatory lesions do not heal completely, leaving a tiny hole (fistula).

The vast majority of situations with this disease occur spontaneously in completely healthy children. However, the cause of the problem may be related to the use of diapers (diaper rash, irritation), inflammatory disease intestines, weakened immune system.

The causes of paraproctitis can be given by:

• dilation and inflammation of hemorrhoidal veins;
• anal fissures;
• abnormalities of the glands in the rectum;
• inflammation of the respiratory system;
• intestinal dysbiosis;
• inflammatory diseases of the rectum and other parts of the intestine;
• bowel disorder (diarrhea, constipation).

The causative agent of infection in infants is mainly coli, less commonly staphylococci, enterococci and anaerobic bacteria.

There are several mechanisms of infection affecting the tissues surrounding the rectum: penetrating trauma to the mucous membrane, infection through the ducts of the glands.

Inside anal canal, about 1-2 cm from the anus, in most children there are small pits in the wall. An abscess caused by paraproctitis and (subsequently) fistulas occur under the influence of infection in them. Exacerbation of the problem with deeper localization (3-10 mm) is mainly associated with an imbalance of estrogen.

Symptoms

This disease begins suddenly and is characterized by violent clinical picture. Here general symptoms which may appear in the first hours after the onset of the disease: pain around the rectum and anus; pain radiating into groin area, perineal area, abdominal cavity.

The child will not be able to stay in sitting position because of pain. Acute and chronic types of diseases such as paraproctitis can be. Chronic disease often called a rectal fistula.

There are several classifications depending on the symptoms acute type of this disease. The subcutaneous type is located just under the skin and is the most common type of the disease.

Submucosal purulent paraproctitis occurs in the rectum itself under the mucous membrane. In addition, inflammation can be deep or superficial.

It is difficult to define this disease because most children who suffer from it are at an age when they cannot yet speak.

Parents should pay special attention to:

• increase in temperature;
• frequent screams of the child, especially during bowel movements;
• constipation

As a rule, children suffer from subcutaneous paraproctitis, therefore, the skin around the anus will become red and swollen.

The process of inflammation in acute paraproctitis spreads even deeper along the rectal glands to the surrounding tissues.

The infection then eats away soft fabrics and through the wall of the anal canal penetrates into the fatty layer under the skin of the perianal area.

In children early age(pediatric subgroup), among which this disease is the most common; according to statistics, the incidence ranges from 0.5 to 4.3% with an overwhelming predominance among males. Paraproctitis is the most common disease of the rectum after hemorrhoids.

Severe pain will disturb the baby both when urinating and when defecating. Painful swelling of the anus and redness of the skin will appear.

Before starting treatment, the doctor must familiarize himself with the results of a complete blood test of the child, a urine test, and the level of glucose in his blood.

Basically, doctors advise trying to achieve complete elimination of the problem with antibiotic therapy alone, without surgery, which involves general anesthesia. This approach to treatment and its timeliness can reduce the likelihood of fistula formation.

Oral antibiotics can also help with this. Conventional drugs, suitable for fighting infection, are represented by Cephalexin and Amoxicillin. For all patients prescribed antibiotics, parents will need to see their doctor a few days after starting therapy, and then weekly until the infection is completely cleared.

Treatment with antibiotics

Doctors prescribe intravenous antibiotic therapy for children who exhibit signs of a systemic disease secondary to infection, for example:

• pallor;
• lethargy (the baby will not be as energetic as usual);
• fever;
• violation of feeding, sleep, bowel movements.

However, the need for intravenous antibiotic treatment is extremely rare.

Surgery

Surgical treatment of a chronic abscess is carried out by a proctologist surgeon, because in this case more complex operation. But initial examination, as a rule, is performed by a surgeon.

Children who had to help solve this problem surgically, parents will have to show doctors every week until the site of inflammation has completely healed. Later, visits to the doctor will occur every 3 months. If relapses do not occur within six months, the child can be considered healthy.

Doctors will advise parents that if a drop of blood is detected in a diaper, non-standard type mass of stool, bleeding in a child, they should urgently contact a specialized medical institution.

The postoperative period should also be accompanied by short warm baths for the baby each time after bowel movement.

At this time, the doctor prescribes antibiotics for the baby to prevent recurrence of paraproctitis. Medicines will also help prevent infection of other body systems and the occurrence of complications such as sepsis or peritonitis.

After surgical intervention doctors may also recommend antibacterial therapy(Cefotaxime, Gentamicin, Amikacin) and perform daily dressings with antiseptic ointments (Levomekol).

Complications

During the recovery period, it is very important to follow the correct intimate hygiene baby. Parents should wash his rectal area twice a day, morning and evening, and after each bowel movement to prevent infection of the postoperative wound.

There may be dangerous complications acute paraproctitis, among which doctors distinguish:

• purulent infiltration, which can damage the intestinal walls;
• cases when, with subcutaneous localization, the rupture of an abscess (a limited cavity with pus) can be external, which leads to additional infections;
• damage to adipose tissue in the pelvic area;
• peritonitis due to the rapid spread of inflammation towards the abdomen;
• rapid progression of the disease due to purulent melting in the intestine above the rectal area.

Even if the surgeon follows all the rules of surgery, bleeding may occur, infectious complications and other postoperative problems. It should be borne in mind that delay in contacting a doctor in case of symptoms of the disease can lead to tragic consequences.

Thus, the only way To prevent complications is to seek medical help early.

Paraproctitis in children under one year of age should be given special attention. In case of untimely detection or improper treatment The consequences of this disease in young children can be disastrous.

To prevent this from happening, you need to know what paraproctitis is, what are the causes of its occurrence in infants, the main symptoms, methods of treatment and prevention.

Causes of paraproctitis in infants

This is a serious disease associated with purulent inflammation of the tissues bordering the lower rectum. Due to infection staphylococcal infection a purulent focus of inflammation forms in this area with the appearance of symptoms characteristic of this condition.

Otherwise, when the mature suppuration comes out, a fistula is formed, requiring long-term treatment.

Common factors that contribute to the formation of paraproctitis in young children are:

• constipation or loose stool traumatic perianal area;
• violation of hygienic rules of care (long stay in diapers, insufficient cleanliness of the perineal area);
• various pathologies anal mucosa.

Paraproctitis is often observed in infants, since their unformed immune system is not able to fully resist pathogenic bacteria that have penetrated into the rectal tissue through microtraumas of the mucous membrane and skin. In children after one year of age, the incidence rate decreases sharply.

Boys are most susceptible to this pathology due to the anatomical features of the body.

Another difficulty in the course of paraproctitis in infants should be considered the morphological feature of the structure of the anal glands with numerous branches and canals, ensuring rapid development inflammatory process.

Signs of acute and chronic forms of paraproctitis in infants

Paraproctitis in newborns can occur in acute or chronic form. It is important for parents not to miss the onset of the disease due to the child’s changed behavior and promptly consult a proctologist in order to avoid dangerous consequences.

Acute paraproctitis in infants occurs for the first time and is clearly manifested the following symptoms:

• strong crying during bowel movements and urination (this is detected in small children severe pain V anus);
• redness and swelling skin in the anal area;
• soreness in the anal area when touched while changing a diaper or performing hygiene procedures;
• sharp increase body temperature;
• deterioration general well-being;
• constant moodiness.

In some cases, upon careful examination of the child's perianal area, pus may be seen. But the source of inflammation can occur both subcutaneously and deep inside.

The acute form of the disease develops quite quickly - within 2-3 days. After the specified period, the abscess may spontaneously open, which will lead to negative consequences.

Acute paraproctitis can become chronic. Sometimes in newborns the presence of a fistula in the perianal area is congenital pathology.

The main symptom of this form of the disease is a fistulous tract, which, when visual inspection can only be detected when it is located externally.

The internal fistulous tract can only be determined by a specialist by thorough examination baby. The chronic course of the disease is characterized by a wave-like change of periods of exacerbation with remission, when the fistula spontaneously closes for a while.

You should know that anal fistulas require urgent medical attention; they cannot disappear on their own.

In case of an advanced form of the disease or improper treatment small child may die due to severe intoxication of the body resulting from a widespread infectious process.

Diagnosis of paraproctitis in infants

If an inflammatory process is detected in the lower part of the rectum in your small child parents should immediately seek help from a pediatric proctologist.

Specialist before staging accurate diagnosis will hold a series diagnostic measures. These include:

• a detailed survey of parents about the child’s changed behavior;
• external examination of the diseased area and general condition baby health;
• finger examination;
• rectal probing;
• fistulography;
• clinical and biochemical analysis blood;
• examination of the contents of the abscess.

Initial inspection of the problem area near anal passage will indicate signs of paraproctitis in an infant: overflow of skin vessels with blood, swelling, induration and severe pain when touched lightly.

The fistulous tract and abscess in the perianal area in an infant are easily detected experienced specialist using palpation. Other instrumental methods of examination are necessary to determine the exact location of the fistula tract, its location in relation to the child’s anus, and the size of the abscess.

By laboratory diagnostics the patient's blood confirms the presence bacterial infection. Examination of the contents from the abscess will allow us to determine the sensitivity of the causative agent to antibiotics, which will help in the future to prescribe effective treatment.

Treatment of paraproctitis in young children

Treatment options for acute and chronic paraproctitis in very young children may vary. If a lesion in the perianal area with purulent contents is detected in a child, the only treatment option is surgical intervention, which is performed under general anesthesia in hospital medical institution.

During the operation, the abscess is opened and the cavity is sanitized antiseptic solutions and antibiotics, installing a special drainage to remove purulent contents out. If there is a fistula tract extending from the rectum, the surgeon carefully removes it.

Surgical intervention in children under 2 years of age is carried out in 2 stages:

1. Suppuration is eliminated and a drainage system is installed.
2. After a few days, if the dynamics are positive, the drainage is removed.

Surgical treatment is combined with drug therapy, special diet, hygiene procedures. A weekly course of antibiotic treatment is given wide range actions.

Baths with a solution of potassium permanganate are prescribed after each child's toilet. Difficulties in bowel movements are eliminated with the help of mild cleansing enemas.

With a high-quality operation and correctly prescribed conservative treatment, the baby makes a complete recovery.

Treatment of the chronic form of this pathology, diagnosed in a child under 2 years of age, includes a conservative approach until the fistula tract is fully formed, and then surgery to remove it.

Conservative treatment of infants consists of:

• careful hygiene of the perineal area;
• avoiding constipation or loose stools;
• bathing in weak solution potassium permanganate;
• taking antibiotics;
• ultraviolet irradiation of blood.

The delicate skin of a child is thin and vulnerable. A slight violation of hygiene in the anal area (diaper rash, loose stools or constipation) is enough for it to become damaged and an inflammatory process develops - paraproctitis. Boys and girls are affected with equal frequency.

What is childhood paraproctitis?

The inflammatory process in the rectal gland is called paraproctitis

Paraproctitis is an inflammatory process in the tissue of the lower rectum. Children in the first year of life are most susceptible to the disease. It has to do with immaturity. immune system and inability to resist infectious agents that cause inflammation in the rectum. Pyogenic microbes penetrate the rectal tissue through cracks or microtraumas of the mucous membrane, thus developing purulent inflammation. If treatment is not started in a timely manner, pus comes out either outside or into the abdominal cavity, which leads to peritonitis. This complication extremely dangerous for the baby.

According to statistics, 60% of the sick are children from 1 to 6 months, 20% are from 6 months to a year. With increasing age, the incidence rate decreases.

Video about paraproctitis in infants

Reasons for the development of the disease

Paraproctitis occurs in a child in the same way as in an adult. The disease begins with inflammation of the anal sinus or gland. Then the infection spreads to the rectal tissue, the inflamed areas are separated from the healthy ones, forming a local abscess. If therapy is not started on time, the abscess opens outwards or into the rectum, forming a fistulous tract - the disease becomes chronic.

The difference between the disease in infants is that they have abnormal ducts of the anal glands, which have numerous channels and branches. This structural feature explains the rapid spread of the inflammatory process, the severity of the disease and the presence of serious complications.

The main predisposing factors for the development of paraproctitis include:

• frequent loose stools, which is not uncommon in infants. The skin of the perianal area is quickly damaged and serves entrance gate for infection;
• fecal retention. Constipation is also common in children in the first year of life. Solid feces when passing through the rectum can injure its mucous membrane. Through the resulting wounds, pathogenic microflora penetrates the anal crypts or glands;
• congenital pathologies of the rectal mucosa;
• insufficient hygiene of the perianal area, diaper rash;
• immaturity of the child’s immune system.

Symptoms

Basic clinical symptoms diseases depend on its form. Acute paraproctitis (newly occurring) is characterized by:

• increase in body temperature to subfebrile (from 37 to 38 C) or febrile (from 38 to 39 C);
• causeless crying, capriciousness of the child, aggravated by the act of defecation;
• baby's refusal to eat;
• redness and swelling in the anal area;
• increased anxiety during diaper changing and toileting of the external genitalia;
• Symptoms worsen when sitting.

The inflammatory process progresses quickly and after 2-3 days the general symptoms increase: the child sleeps poorly, does not eat, and is inactive. Children over a year old they try not to sit down or sit only on the healthy side, walk with their legs wide apart, and complain of pain during bowel movements.

IN general analysis Inflammatory changes are expressed in the blood:

• shift leukocyte formula left;
• increased ESR (erythrocyte sedimentation rate);
• increase in leukocyte levels.

During palpation of the rectum, an abscess is identified, its size and location are specified.

If the disease is not treated, on days 5–7 the abscess spontaneously opens outwards or into the rectum, which often leads to the development of local and general complications.

In chronic paraproctitis, a sign of which is the presence of a fistula tract, the clinical picture is the same as in acute paraproctitis, but in a milder form. Exacerbations can occur up to 6 times a year. Sometimes the fistula closes spontaneously long time.

Treatment

For everyone age groups children the only one radical method The treatment for acute paraproctitis is surgical intervention.

Very rarely, when the process has just begun, conservative treatment methods can be used:

• warm baths with a solution of potassium permanganate;
• taking antibiotics;
• warm microenemas;
• ultraviolet irradiation of blood.

• antibiotic therapy;
• bathing in a weak solution of potassium permanganate;
• thorough toilet of the perineum;
• elimination of provoking factors (constipation, loose stools).

Conservative treatment methods in the photo

Careful care of perineal hygiene helps to avoid the development of the disease Warm microenemas relieve paraproctitis Ultraviolet irradiation blood causes the death of microorganisms and improves immunity

As a rule, everything conservative measures are preparation for surgery. The purpose of surgery is to open the abscess and sanitize the cavity.

Features of the operation

In children under 2 years of age, the operation is carried out in two stages:

1. First, the abscess is opened and the pus is removed, leaving drainage in the cavity, and antibiotic therapy is prescribed.
2. After 3-4 days, when the child’s condition improves, the second stage is carried out - the drainage is removed, sitz baths with a solution of potassium permanganate are used after bowel movements.

IN within three days after surgery, a slag-free diet is prescribed. After 2–3 days of independent bowel movements, cleansing enemas are performed and, as a rule, the child is discharged home for outpatient follow-up treatment. Broad-spectrum antibiotics are prescribed orally for 7 days.

Complete excision of the cavity or resulting fistula is carried out with one radical surgery after the child reaches two years of age. In the postoperative period, antibiotic therapy is continued in all cases; recovery occurs within two months. normal microflora rectum with biological products such as “Bifiform”, “Lactobacterin”.

Important to know: treatment of acute paraproctitis in children traditional methods It is unacceptable without medical supervision! This can lead not only to increased symptoms, but also to the development of serious complications.

Relapses

If the operation is successfully performed and there are no complications in postoperative period The sick baby usually recovers completely. But in some cases - with long-term purulent process in the pararectal area and late surgical intervention, with independent emptying of the abscess, with treatment only conservative methods- may happen relapse of the disease.

Moreover, during the periods between exacerbations, the baby feels absolutely healthy and does not show any complaints. Less often on site former abscess Painless lumps remain, which further cause another outbreak diseases.

All complaints during a relapse are the same as during an acute process. Everything goes away after spontaneous opening of the abscess or after surgical intervention. Treatment of relapses is carried out in the same way acute form diseases. To prevent repeated exacerbations, preventive measures must be carefully observed.

Prevention

All preventive measures are available; only strict regularity of their implementation is required.

To prevent the disease and prevent its recurrence, the following measures are necessary:

• general strengthening procedures that promote the formation of immunity - walks on fresh air, hardening, normalization of sleep and wakefulness, organization of a healthy, balanced diet;
• regular, careful care of the baby’s external genitalia, compliance with hygiene rules;
• exclusion of microtraumas to the skin of the perianal area and rectal mucosa;
• prevention of constipation in a child and normalization of intestinal microflora in case of loose stools;
• Regular visits to the pediatrician and examination of the child.

Paraproctitis in young children - serious illness. Its treatment must be approached responsibly and in a timely manner. With the right therapy, following the doctor’s recommendations and following preventive measures manages to achieve full recovery little patient and avoid relapses of this terrible disease.

Despite the fact that paraproctitis is a fairly common disease in children, it does not develop so often. The male population aged 20-50 years is more predisposed to it, it occurs this disease and in women. Nevertheless, although rare, paraproctitis still occurs in children. As in adults, it can be acute or chronic.

What causes paraproctitis to develop?

In most cases, paraproctitis develops in infants, with about 60% being infants under 6 months, 20% from 6 to 12 months. After this age, the risk of developing of this disease is significantly reduced.

Paraproctitis occurs in principle for the same reasons as in adults. The cause of the disease is an infection that enters the cellular space from the rectum. This can be facilitated by:

• microtraumas;
• cracks;
• blockage of the anal gland duct.

TO similar pathologies usually lead to constipation, hemorrhoids, and diarrhea. The intestinal mucosa can be damaged by administering an enema. After infection, only the intestinal crypt or the mouth of the gland becomes inflamed at first. Gradually, the infection spreads to the deeper layers of the intestinal wall. Then it moves to the adjacent perirectal tissue, the affected areas are delimited from healthy ones, resulting in the formation of an abscess (abscess). In other words, paraproctitis occurs.

The fact that paraproctitis most often develops in children under one year of age is explained by several factors:

• unformed immune system;
• frequent bowel movements, constipation or diarrhea that are common in infancy;
• high vulnerability of the rectal mucosa and the skin next to it.

If in adults paraproctitis is usually caused by an infection such as Escherichia coli, in children it is staphylococcus. The cause of the disease in babies may be abnormal ducts of the anal glands. Because of this morphological features buildings they have additional branches, this creates favorable conditions for the development of inflammation.

Signs of an acute form of the disease

As a rule, acute paraproctitis is accompanied by pronounced symptoms; they may differ somewhat depending on the location of the inflammation, its size, and the level of the body’s resistance. Characteristic features disease is:

• increased body temperature, it can reach 38 degrees or more;
• manifestations of intoxication - headaches, weakness, malaise, loss of appetite, joint and muscle pain;
• pain of varying intensity in the pelvic area, lower abdomen, rectum, usually aggravated by defecation. The presence of pain in a child under one year old can be guessed by increased crying during bowel movements;
• pain in the anus;
• on the skin near the anus there is a compacted, reddened area that is hot to the touch.

Most often, infants develop subcutaneous paraproctitis. It can be easily identified visually by redness, swelling and thickening of the tissue near the anus. Often, with this disease, the child cannot take a sitting position.

When the abscess is located deeper, for example, in the pelvic-rectal form of the disease, the symptoms increase gradually, at first only elevated temperature, then minor ones appear painful sensations, which intensify over time. Visually, such acute paraproctitis in a child can be determined in no less than a week, since the skin near the anus remains unchanged until then.

If adequate treatment of acute paraproctitis is not carried out in a timely manner, the abscess usually opens spontaneously in subcutaneous tissue or out. After this, the sick child’s condition quickly improves - the temperature drops, the pain decreases or disappears altogether. In this case, purulent-bloody discharge may begin to come out of the rectum.

Often, when an abscess spontaneously opens, a fistula tract is formed and the disease becomes chronic course. However, in such a situation it is also possible various complications. The consequences of acute paraproctitis in children can be as follows:

• opening the abscess to the surface of the skin;
• damage to the pelvic tissue;
• melting of the rectal abscess with the contents; in girls, the vagina may be damaged;
• melting of the intestinal wall located above the anorectal zone and widespread infections;
• breakthrough of the abscess into the abdominal cavity and the development of peritonitis.

Most a common consequence Acute paraproctitis is the formation of a fistula tract and the transition of the disease to a chronic form.

Signs of a chronic form of the disease

The main symptom of chronic paraproctitis in children is a fistulous tract, which most parents pay attention to even without inflammation. Depending on the location, fistulas are divided into:

1. Full. In this case, the fistula opens onto the skin and into the rectum.
2. Incomplete open. They only come out on the skin and do not contact the rectum.
3. Incomplete closed. They open into the rectum and end in fatty tissue.

During the period of remission, children usually feel well, they may be bothered by very minor pain, and often there is no pain at all. Scanty purulent-bloody discharge is sometimes observed from the opening of the fistula. When the fistula tract becomes clogged with granulations, pus or dead tissue, impeding the outflow from the tissue, inflammation develops with characteristic symptoms:

• pain;
• increased body temperature;
• redness of tissues, etc.

In general, the symptoms of an exacerbation of chronic paraproctitis are identical to the acute form of the disease, the only thing is that they may be slightly less pronounced. When the abscess is opened, the patient’s condition returns to normal, and remission occurs for some period.

Features of treatment

Today there are no more effective way treatment of paraproctitis than surgery. It is used both for acute and chronic forms of the disease. However, in the first case only emergency surgery, in the second - it can be planned. In progress surgery under general anesthesia. During it, the abscess is opened, the glands and crypt involved are removed, and the affected area is drained. If there is a fistula, the surgeon excises the fistula, removes scars, opens and cleanses purulent cavities. As a rule, after surgery there is a complete recovery.

In some cases, treatment of fistula in children can be carried out using conservative methods. The main goal of this treatment is to prevent infection of the fistula tract. For this, the following activities are recommended:

• Sitz baths with a solution of potassium permanganate. It is important to ensure that the solution is not strong and pale pink. It is recommended to bathe children who cannot yet sit in it 2-3 times a day.
• Skin care near the anus, timely removal of feces;
• According to indications, it is possible to use antibacterial agents.

Apply conservative treatment only when chronic forms illness before the timing of the operation is finally established. It can also be prescribed if the surgical intervention is adjusted until the fistula tract is fully formed (this usually happens by 2 years).

It turns out that most often paraproctitis is inflammation of the tissue surrounding lower section rectum in children occurs before the age of 6 months.

Unfortunately, this is precisely the age when the child cannot yet say or even show what is bothering him. At the same time, paraproctitis (the concept is derived from the words para - next, proctos - rectum) - quite dangerous disease even for adults. With paraproctitis, a purulent focus forms near the rectum, which can cause severe intoxication, fever in the child, and if left untreated, even break out. If an abscess located next to the rectum breaks into the intestinal cavity, a fistula is formed, which may require long-term treatment. If the abscess breaks into the pelvic cavity, then the inflammation can spread up to abdominal cavity with the development of peritonitis.

What are the reasons for the development of paraproctitis in children?

In principle, they do not differ from the causes of this disease in adults. Paraproctitis occurs when bacteria through anal glands(glands located in the final part of the rectum), damaged rectal mucosa or damaged skin enter the tissue that surrounds the rectum. However, in newborns and young children, the skin next to the rectum and the mucous membrane itself lining the intestine from the inside are much more vulnerable and can be easily injured - which, for example, can happen with constipation. In addition, in a small child, one should not forget about such a factor as maceration of the skin (violation of its integrity), which occurs, among other things, with diaper rash, frequent loose stools, constantly wearing diapers and simply violating hygiene rules. For example, if the rectal area is contaminated feces, rarely washing the child, using aggressive cosmetics for washing.

Over the course of a year, several dozen children are operated on for paraproctitis in Yekaterinburg. Moreover, their number is growing every year. Only during 2012 in the department of purulent surgery of the Children's City clinical hospital No. 9 (children over 6 months of age are operated on here) and in the neonatal surgery department of the Regional Clinical Hospital No. 1, 84 children were operated on. For comparison, in 2008, 51 patients with this disease were treated in both departments.

At what age do children most often suffer from paraproctitis?

Judging by the statistics of two departments where children with paraproctitis are admitted in Yekaterinburg, 62% are children aged 1 to 6 months. Another approximately 20% - from 6 months to 1 year. Then, with age, the risk of developing paraproctitis decreases.

There is another feature of this disease - it is that boys most often suffer from paraproctitis (in 95% of cases). This is due to anatomical features, due to which the pressure in the rectum in girls is less, and the risk of infection penetrating through the wall of the rectum is not so high.

What is characteristic of paraproctitis and where does it begin?

So, it is typical for paraprotitis (and based on these signs it can be suspected):

1. Acute onset

2. Child's anxiety

3. Increase in body temperature - including up to high numbers - 39C or more

4. Intoxication - loss of appetite, weakness, lethargy, decreased emotional background

5. Pain during defecation is practically the only specific sign by which paraproctitis can be suspected. A child may cry during defecation, and at an older age, point to the place of pain. How younger age child, the higher the risk that due to severe pain he will experience stool and urination retention.

6. Discharge of pus to the outside - with paraproctitis, this happens when the abscess breaks through, when a fistula tract forms between it and the intestinal cavity.

External signs of paraproctitis (see picture)

1. Skin redness, local increase temperature in the area of ​​the external opening of the rectum
2. Local swelling
3. Infiltration of surrounding tissues (their compaction)
4. Deformation of the rectal outlet
5. Purulent discharge
6. Pain when touched

What to do if you suspect paraproctitis in a child?

In the case where the child has predominant local symptoms, No high temperature, severe pain, then in order to confirm or refute their doubts, parents should first contact a surgeon at the clinic at their place of residence.

If the child is small (at a “critical” age for paraproctitis - about 6 months), he has sharp pain during bowel movements or near the rectum, and the body temperature is elevated - it is necessary to call ambulance, which, after examining the patient, will deliver him either to the emergency department of CSCH No. 1 (if the child’s age is under 6 months), or to Children’s City Clinical Hospital No. 9 (if the age is over 6 months and up to 14 years).

In the emergency department, the child is examined by a surgeon, tests are carried out - a general and biochemical blood test, a urine test, and if pus is released - he is also taken for bacteriological examination(to determine the causative agent of infection and its sensitivity to antibiotics).

And, if the diagnosis of paraproctitis is confirmed, the child is operated on the same day. The operation, if the process has not gone far, takes up to 15 minutes, but must be performed under general anesthesia. During it, the surgeon opens the purulent lesion, cleans its walls and, if necessary, sutures the gate into which the infection has entered (he dissects the causative crypt through which the infection entered from the rectum). In the event that the child has already formed a fistula, the purulent focus has grown significantly in size or it is deeply located - the operation can be longer, and in the case of a fistula, even repeated (then it is first performed complete emptying purulent focus, and then after the inflammation subsides - closure of the fistula tract). In this case, the child will be in the hospital for a longer time, and usually for treatment of paraproctitis in surgical department it takes 2 weeks. At this time, the child must be prescribed antibiotics, bandages with antiseptic solutions after surgery, and physical therapy.

Doctors especially emphasize that paraproctitis cannot be cured by any “tested home” methods, including antiseptic ointments, baths, and so on. Prescribing antibiotics will not help with paraproctitis if the purulent focus of inflammation itself remains unoperated.

Prevention of paraproctitis in children

After discharge from the hospital, a child who has undergone surgery for paraproctitis will continue to be monitored by a pediatrician and a surgeon. It is also very advisable to show it to an immunologist and analyze what led to the disease - constipation or, on the contrary, too frequent loose stools, weakened immunity or violation of hygiene rules.