Abscess (fistula) of the rectum: symptoms, causes and treatment

There are contraindications. Specialist consultation is required.

A furuncle is a purulent inflammation of the hair follicle. It develops due to staphylococcal infection entering the sebaceous glands due to microtraumas, non-compliance with hygiene rules, excessive sweating, allergies, and decreased immunity. By the nature of the rashes there are single and recurrent, in form single and multiple (furunculosis).

Anatomy of the rectum and perianal region, functions of the obturator apparatus

The rectum and anal canal are the final sections of the digestive tract. The immediate tasks of the rectum are the accumulation, formation and excretion of intestinal contents and gases. The functions of the anal canal are unique: a system of nervous reflexes and a complex muscle complex provide one of the most important functions of the body - control of bowel movements, as well as differentiation of the composition of intestinal contents without the need for conscious assessment and subsequent “smart” control of evacuation. In other words, a healthy person most of the time does not think about what kind of contents are in the rectum, whether it is necessary and whether it is possible to retain it in a given situation. All this is controlled unconsciously, thanks to multi-level neuromuscular self-regulation of the holding process.

The approximate boundary between the rectum and the anal canal on the side of the mucous membrane (lumen) of the intestine is formed by the so-called dentate line. There are vertical folds on it, alternating with depressions - crypts. The ducts of the anal glands open into the crypts. The mucus produced by these glands facilitates the sliding of intestinal contents as they pass through the anal canal. Circumstances such as trauma, swelling of the mucous membrane due to defecation disorders, chronic intestinal diseases can lead to inflammatory changes in the crypts and anal glands.

Outside the mucous membrane there is a complex of muscles - these are the sphincter muscles mentioned above, which provide the function of retention and excretion. There are internal and external sphincters. The internal sphincter forms the so-called resting tone, uninterruptedly ensuring the tightness of the anal canal. Its regulation and reduction occur unconsciously, that is, without our will. The external sphincter surrounds the internal one and consists of several layers (portions). Its reduction occurs due to our volitional effort (Fig. 1).

Figure 1. Schematic representation of the rectal sphincters

What is a fistula

A fistula is a pathological, normally non-existent, passage in the form of a tube connecting the lumen of a hollow organ with the external environment or the lumen of another organ. A rectal fistula, a kind of “tunnel,” connects the lumen of the rectum with the skin of the perineum, buttocks or (rarely) other hollow organs, sharply reducing the patient’s quality of life. This pathological process can involve a large portion of sphincter muscles, which initially characterizes such a fistula as complex and does not allow for “minimally invasive” treatment. In such a situation, a careful assessment of the degree of involvement of muscle structures and planning of special techniques for economical excision of the fistula with subsequent plastic closure of the resulting defect are required.

Important! Such operations must be performed by expert surgeons with extensive experience in such interventions, otherwise the likelihood of relapse (recurrence of the disease) increases several times.

Fistulas have the following structure:

- internal opening: it is usually the affected anal crypt (that is, the most terminal part of the gland duct). The crypt is connected by a duct to the anal gland, located in the space between the sphincters. It is the inflammation of this gland that in the vast majority of cases leads to the development of the disease (Fig. 2).

Figure 2. Stages of fistula formation: a) - anal gland with an excretory duct, b) - inflammatory process in the gland, with a forming abscess (abscess) c) - formed fistula tract.

• fistula tract, which can be tortuous, have cavities and branches
• external opening: but most often located on the skin of the perineum near the anus (Fig. 3), sometimes in the vagina or urethra (urethra).

Important! If you have the slightest suspicion of a rectal fistula, you should immediately consult a specialist. If treatment is untimely or inadequate, the disease can be complicated by acute inflammation and additional purulent leaks, which significantly worsens the prognosis!

However, it also happens that the fistula tract ends blindly in the pararectal (peri-rectal) tissue, tissues of the perineum, buttocks, that is, it has only an internal opening of the fistula, which opens from the mucous membrane of the rectum and has no “exit” to the outside.

Figure 3. External opening of the fistula

What diagnoses can fall into the category of “abscess on the gums”?

• Exacerbation of chronic periodontitis;
• Exacerbation of chronic gingivitis (periodontitis).

Suppuration also occurs after tooth extraction (alveolitis), with cancer, with fractures (osteomyelitis) - these conditions are also accompanied by the release of pus, but here the patient (in most cases) knows about the cause (a tooth was recently removed, there was a fracture, etc.). d.). Sometimes manifestations of diseases of the mucous membranes are confused with ulcers - aphthous stomatitis, herpetic stomatitis and others, which also appear as a white (white-yellow/gray) area of ​​the mucous membrane with a red rim around, but as such there is no pus there, and the causes of these conditions are also different. Therefore, we will talk more about periodontitis and periodontitis.

How common is rectal fistula?

The incidence in European countries is about 10-25 people per 100 thousand population. Mostly people of working age suffer from rectal fistulas. Men get sick 2-3 times more often than women.

Important! This disease, being benign, can dramatically reduce a person’s quality of life. A serious and most common complication of inadequate treatment of perianal fistulas is impaired holding function due to damage to the muscular apparatus of the anal canal.

Causes of fistulas

If you experience symptoms characteristic of a rectal fistula, in the vast majority of cases the cause for this was an inflammatory process in the anal gland (Fig. 2). In turn, inflammation of the gland is usually preceded by microtrauma of the anal canal. The cause of such injury is most often excessive irritation and/or trauma to the anal canal when too hard stool passes through the anal canal during constipation or, conversely, during diarrhea. Relatively rare causes of so-called specific fistulas of the anal canal and rectum are inflammatory bowel diseases (Crohn's disease, ulcerative colitis), tuberculosis, rectal tumors, and the consequences of radiation therapy of the pelvic organs. Inflammation of the gland is accompanied by the development of an abscess (ulcer) in the soft tissues of the perineum and is usually characterized by severe pain, which forces the patient to consult a doctor. Timely and correctly performed opening of the abscess leads to rapid relief of the condition, however, according to modern data, about half of all abscesses are accompanied by the subsequent formation of a fistula and require repeated intervention.

It is this repeated intervention that is aimed at radically getting rid of the fistula and requires not only an extremely thoughtful approach to the choice of treatment tactics, but also extensive surgical experience on the part of the surgeon.

Important! Opening an abscess is a relatively simple operation, but if performed incorrectly, it is at this stage that the muscular complex of the anal canal is most often damaged, which leads to disruption of the function of controlling intestinal contents!

If your visit to the doctor is postponed, the abscess may open on its own with the release of pus, after which your health usually improves and the pain in the perineal area decreases sharply. Symptoms may subside or disappear completely for a period of several weeks or months to many years. Despite the improvement in general well-being, spontaneous opening of an abscess is a relatively unfavorable scenario, because in this case, there is no complete evacuation of the contents of the purulent cavity, but only part of the purulent discharge occurs through the formed hole, which can soon close again. Proper treatment of an abscess consists of creating adequate drainage by creating a sufficient hole, evacuating the contents, rinsing the abscess cavity with antiseptic solutions and, if possible, removing the inflamed gland that is causing the inflammation.

Important! Sometimes, in the hands of an expert surgeon, with the relative simplicity of the fistula tract, radical excision of the fistula at the stage of surgical opening of the abscess is possible, but performing this intervention is extremely dangerous in the hands of an insufficiently experienced specialist and today is not recommended in most international recommendations.

When an abscess spontaneously opens, the likelihood of a return of the acute disease increases and the process becomes chronic with the formation of a fistula. A long course of the disease with periodic exacerbation leads to scarring of the surrounding tissues and, most importantly, the sphincter muscles responsible for the holding function. In addition, in conditions of constant inflammation, a relatively simple fistula can give rise to additional passages and leaks, which significantly complicates subsequent treatment.

Timely consultation with a doctor at an early stage of the disease can reduce the likelihood of developing a fistula and such dangerous complications of the inflammatory process as pelvic phlegmon. Therefore, even minor symptoms that do not significantly affect the quality of life require attention and evaluation by a qualified specialist.

How to treat an abscess on the gum with folk remedies?

In both cases, the cause of the development of the process is an infection that sits deep in the gum or bone. This means that we still won’t be able to influence it directly. Traditional methods (rinsing with herbs, applying propolis, etc.) usually bring their results: the fistula really goes away for a while. BUT! All these methods remove the effect, not the cause! Until the microbial contamination is removed, inflammation will progress. It won’t cause such discomfort, but it certainly won’t go away on its own.

Therefore, treatment should begin with a visit to the dentist to determine the cause. And only then, when you identify the cause and begin to fight it together with the doctor, you can also use traditional therapy, since rinsing with herbs really gives a good result after removing the stone, and, for example, sea buckthorn oil slightly speeds up the healing of wounds on the mucous membrane.

What types of fistulas are there?

Traditionally, rectal fistulas are classified according to their location relative to the sphincter muscles. In accordance with this, intrasphincteric, subcutaneous-submucosal, intersphincteric, transsphincteric, suprasphincteric, extrasphincteric fistulas are distinguished (Fig. 4).

Figure 4. Types of fistulas

1. Extrasphincteric fistula
2. Low transsphincteric fistula
3. Subcutaneous submucosal fistula
4. Suprasphincteric fistula
5. Intersphincteric fistula

The fistula tract can be located at a short distance from the edge of the anus and occupy no more than 1/3 of the lower part of the sphincter muscles - then they speak of a low (simple) fistula, or go high up, crossing a significant portion of the muscle complex - these are high (complex) fistulas. The complexity of the fistula is determined not only by the degree of muscle involvement, but also by the presence of swelling, active inflammation, and the presence of scarring around the fistula.

Subcutaneous-submucosal fistulas are the simplest fistulas. Simple fistulas also include intra- and intersphincteric fistulas. The fistulous tract in this form is usually straight, without streaks or cavities, and involves a minimal number of muscle fibers, thus not disrupting the function of the sphincter. Intersphincteric (intrasphincteric) fistulas pass through the internal sphincter into the intersphincteric space and then extend to the perineum. The external sphincter is not involved. As a rule, such fistulas are also simple and do not pose any difficulties for surgical treatment.

Transsphincteric fistulas of the rectum are more common than extrasphincteric fistulas and can affect more extensive layers (portions) of the sphincter complex. In this case, the fistula tract involves both external and internal sphincters.

Important! Tortuous fistula tracts, purulent cavities in the peri-rectal tissue, scarring in the surrounding tissues (including the sphincter) are more common if the fistula is located high in relation to the sphincter.

Suprasphincteric (from supra - above (lat.)) fistulas, starting in the intersphincteric space, rise upward and cross the muscular structures of the anal canal at its highest point, thus involving the entire obturator apparatus.

With such fistulas, high blind branches can form, which can sometimes be identified through the wall of the rectum.

In 3-5% of cases, extrasphincteric fistulas occur, in which the fistula tract goes around the external sphincter, and the internal opening of the fistula is low, in the area of ​​the crypts. These fistulas are characterized by the formation of a tortuous course, streaks, and cicatricial changes.

In addition, additional fistula tracts may extend from the main fistula tract in various directions, and along the fistula, cavities with accumulation of mucus, pus, and necrotic (destroyed) tissues may form.

If the patient has already undergone surgery to eliminate a rectal fistula, and the symptoms of the disease resume after some time, the fistula is called recurrent.

Important! Treatment of recurrent and postoperative fistulas should be carried out only in specialized clinics and only by experienced surgeons!

Exacerbation of periodontitis

Cause and mechanism of development

Periodontitis is an inflammatory disease associated with infection in the bone at the apex of the tooth root. Infection can enter the bone in different ways: through a tooth root canal or through a periodontal pocket.

1. In the first case, the development of the disease begins with caries. If caries is not cured in time, the infection spreads deep into the tooth and causes pulpitis, and if further untreated, microorganisms spread deeper along the neurovascular bundle inside the tooth and reaches the bone.
2. In the second case, the cause of infection in the bone is a problem in the interdental space (deep pocket). Inflammation of the gums can begin due to the accumulation of tartar, due to chronic injury from the sharp edge of a crown or filling, due to improper position of the tooth in the arch, and for many other reasons. Gradually, inflammation from the gums spreads to the circular ligament of the tooth, the ligament is destroyed, allowing microbes access to the space between the tooth root and the alveolar bone.

In both cases, the entry of microbes into the bone is accompanied by the release of a large amount of toxins, the bone begins to deteriorate, and in its place a cavity filled with pus forms. The process can go relatively unnoticed, causing inconvenience to the patient only during periods of exacerbation against the background of acute respiratory infections or other conditions accompanied by a general decrease in immunity.

Gradually accumulating, the pus continues to dissolve the bone, causing the inflammation to become larger. At the moment when the amount of pus reaches a critical level (or, due to a decrease in immunity, it becomes more), the pus begins to look for a way out. The bone gradually dissolves, passages are formed through which pus comes out under the periosteum and at some point a breakthrough occurs. Through this fistula, the pus comes out, and the original process returns to its chronic course.

Symptoms

Outside of periods of exacerbation, manifestations of periodontitis are minimal. This may be discomfort when biting on a tooth, or when pressing on the gum in the area of ​​the causative tooth, but there are no other manifestations.

During the period of exacerbation, the following symptoms occur:

• acute pain when biting on a tooth (before an abscess appears on the gum), and after the fistula opens and the pus flows out, the pain goes away;
• the feeling of a grown tooth (also goes away after opening the fistula);
• pain and swelling of the gums in the area of ​​the causative tooth;
• A whitish bubble appears on the gum, filled with liquid contents, when opened, pus flows out.

Symptoms of general intoxication may occur: fever, general weakness, lethargy, headache.

Diagnosis and treatment

To make an accurate diagnosis, they collect anamnesis, examine the oral cavity and the possible causative tooth, and be sure to take an x-ray.

The x-ray will show dark areas in the bone that are located in the area of ​​the tooth root. The size of these lesions can vary from a few millimeters to a centimeter in diameter or more. Most often, an x-ray can tell you exactly where the source of infection is located, on which root (or between the roots of the teeth). The image determines the condition of the bone, the condition of the causative tooth and a possible prognosis for the future life of the tooth. Based on these data, a decision is made on the treatment method.

Possible treatment options for periodontitis in the acute stage

• Therapeutic treatment. This method involves removing nerve remnants from the canals (or unsealing them if the tooth has previously been treated), antiseptic treatment of the root canals, introducing medicinal drugs into the canal, and after some time (from a week to several months) the canals in the tooth are permanently sealed . It is assumed that with this treatment the source of infection will be removed (more than 90% of microorganisms responsible for the development of periodontitis live not in the bone itself, but in the root canal system, so high-quality canal treatment often leads to complete victory over the infection and restoration of the bone). After time (six months to a year), the bone is completely restored, and the gums heal with the formation of an invisible scar. To speed up the healing of the fistula tract, it is sometimes washed with a weak antiseptic solution or cleaned with ultrasound.
• Surgical treatment with tooth preservation. There are several options for this operation. If the inflammation is at the apex of the root, then the apex of the root is removed (the operation is called “resection of the apex of the tooth root”) and the cavity in the bone is cleaned. This method assumes that the canals are well sealed, at least 2/3 of their length. The second option is to remove half the tooth (hemisection operation). This type of operation is performed on multi-rooted teeth if inflammation is observed on one root, and the second root does not have such problems. The third option (when there is inflammation between the roots in a multi-rooted tooth) - the tooth is left unchanged, and only the bone between the roots of the tooth is cleaned. All these methods assume that the inflammation came from the tooth, and not through the periodontal pocket (since if the infection came through the pocket, then after the intervention the cavity will soon be populated with microbes again, and the inflammation will progress further). For each of these operations there are certain conditions, the observance of which is mandatory for a favorable prognosis. Thus, resection is carried out only if the canal is well sealed, at least 2/3 of the length, hemisection also implies that the root that remains in the bone will be well treated, and cleaning between the roots is carried out only if all canals are well sealed.
• A combination of therapeutic and surgical treatment. If the tooth has not been previously treated (or has been treated, but the canals are poorly sealed), then before undergoing any of the above operations, the tooth must be prepared. Therefore, the canals are treated first, and only then surgical intervention is performed.
• Removal of a tooth. If the focus of destruction in the bone is large (for each patient and for different teeth the concept of “large” will also be different), if the infection came through the periodontal pocket, if the tooth is not valuable for further prosthetics, the canals in it are impassable, there are cracks and there are other - conditions due to which the tooth cannot (or is impractical) to be saved, such a tooth is removed. You need to understand that sometimes doctors leave something that, by and large, would need to be removed, and sometimes, on the contrary, they remove a tooth that could still be fought for. As an example: they leave mobile teeth in elderly people, since they are the only ones that hold a removable denture, or they remove a tooth with inflammation between the roots in a young patient in order to preserve bone volume for future implantation. In any doubtful case (when you can try to treat it, or you can immediately remove it), they focus on a further prosthetic plan. If implantation is planned, it is better to remove all questionable teeth, and if bridges or removable dentures are used, they try to fight for every tooth.

You can read more about treatment and operations in the article about jaw cysts.

Symptoms of rectal abscess

• the presence of a small, painless wound - an external fistula opening on the skin of the perineum or buttocks.
• purulent, mucous or bloody discharge from the fistula opening
• itching, burning, feeling of fullness and discomfort in the fistula area.
• the presence of an internal opening of the fistula, detected upon examination of the mucous membrane of the anal canal (in approximately 30% it is not possible to find the internal opening during examination)

With an incomplete fistula, skin manifestations may be blurred or absent, and symptoms can vary from mild discomfort, a feeling of tightness or fullness, the presence of a lump in the anus, to discharge from the rectum.

When the disease worsens, a painful thickening is observed in the area of ​​the external opening on the skin, the pain is often pulsating, bursting in nature. This may be accompanied by an increase in temperature and general weakness - these are the symptoms of acute abscess or paraproctitis.

Important! Acute paraproctitis should be opened as early as possible, in a surgical hospital!

Sometimes patients mistake the painful process for an exacerbation of hemorrhoidal disease and begin self-medication, which in no case should be done until the correct diagnosis is established!

Which doctor should you contact if symptoms occur?

If you or your loved ones have the described complaints, you should contact a coloproctologist as soon as possible, who, after consultation and examination, will establish a preliminary diagnosis and determine further tactics and urgency of treatment, or, if in doubt about the diagnosis, a list of necessary additional studies.

If surgery is required, you will be offered hospitalization in a hospital, where, after assessing the results of the studies, which, as a rule, do not take much time and are easy to perform, the operation will be performed.

What studies should be performed in preparation for surgical treatment?

Before the operation, you need to perform a number of standard tests, however, if the disease worsens with the formation of an abscess, the operation is performed for emergency reasons, so waiting for test results should not delay surgical treatment.

In addition to general clinical standard laboratory tests, if a complex fistula or deep-seated abscess is suspected, a number of additional diagnostic procedures may be needed: MRI of the pelvis, ultrasound examination of the pelvis and perineal tissue.

As a rule, the external fistula opening is detected during examination, the internal one - during digital examination of the rectum or anoscopy. However, in some cases - with recurrent, complex fistulas - there is a need to trace the fistula tract along its entire length, evaluate its relationship with the structures of the perineum, and determine the presence of additional tracts or leaks. Today, only MRI of the pelvic organs has this capability, due to its high specificity and sensitivity. That is why this study is the main method for diagnosing complex rectal fistulas.

To objectively assess the functional state of the sphincter (that is, how well it contracts and performs its function), in some cases it is necessary to perform anorectal manometry. The indications and need for it in your case will be determined by your attending physician.

In addition, the patient is usually asked to fill out a special questionnaire, the results of which can be used to determine the degree of continentness (retention of solid and liquid stools and gases) before surgery.

In women, it is often necessary to conduct a vaginal examination to exclude communication between the fistula tract and the vagina when the fistula is located anteriorly.

To exclude other diseases of the colon (in patients over 45 years of age, in cases of colon cancer in relatives, in the presence of two or more fistula tracts), a colonoscopy may be necessary.

Treatment of rectal fistula

The only radical treatment for rectal fistula is surgery. The purpose of the operation is to eliminate the fistula and simultaneously preserve the function of the sphincters. These are two mandatory conditions that must be met during treatment. Once the diagnosis is established, your attending physician will tell you about all treatment options for this disease, their risks and the effectiveness of each method, and will also indicate which type of treatment is optimal in your case.

The type of fistula and the degree of involvement of the sphincter in the pathological process determine the choice and extent of surgical intervention.

In case of a low location of the fistula tract, affecting no more than 1/3 of the height of the sphincter apparatus (subcutaneous-submucosal, intersphincteric, low transsphincteric fistulas without additional leaks), the fistula tract is removed within healthy tissues with dissection of a small volume of sphincter fibers, which are then sutured (Fig. 5). For the most low-lying fistulas, an effective method is simple dissection of the fistula.

Figure 5. View of the postoperative wound after excision of the fistula with suturing of the sphincter. Marked stitches on the muscles

With this type of surgical treatment, after excision, a virtually painless wound defect is formed, which heals with the formation of a barely noticeable scar. When using this surgical intervention, cure occurs in 92-97% of cases.

For high or recurrent fistulas, the use of the above method of dissecting the fistula is unacceptable due to the risk of developing incontinence of intestinal contents or gases as a result of damage to a large volume of muscle mass. Instead, the fistula tract is cut out in the form of a tube within healthy tissue. In this case, a defect is formed in the wall of the rectum, which is closed with a small section of the mucous-submucous membrane of the intestine, the so-called plastic surgery with a displaced flap (Fig. 6).

Figure 6. Schematic representation of the operation using a repositioned flap.

Another relatively low-traumatic method for the sphincteric apparatus is the method of ligation of the fistula tract in the intersphincteric layer - LIFT (ligation of intersphincteric fistula tract), proposed in 2007 by the Thai surgeon A. Rojanasakul. During this operation, the area of ​​the fistula is excised through a small access in the projection of the intersphincteric space, the remaining areas of the fistula are bandaged. With this technique, there is no damage to the sphincter, the soft tissue defect is insignificant, and the wound heals faster. However, only the author of this technique was able to achieve outstanding treatment results with a cure rate of up to 94%. Modern world statistics indicate the effectiveness of this operation at the level of 60-70%.

Gingivitis and periodontitis

Cause

Gingivitis is an inflammation of the gums, and periodontitis is a more severe form of the disease when not only the gums, but also the jaw bone are involved in the inflammatory process. Both diseases are often chronic and do not cause the patient much discomfort, but during periods of exacerbation more severe symptoms appear and the patient consults a doctor.

There are many causes of gum inflammation:

• hard and soft dental deposits;
• sharp edges of crowns and fillings, which constantly injure the mucous membrane;
• improperly restored contact points between teeth (due to which food accumulates in the gap, puts pressure on the gums and is an excellent place for microorganisms to settle);
• malocclusion (crowding of teeth, incorrect position in the arch);
• general diseases (diabetes, vascular problems, infectious diseases and others) can cause gum inflammation;
• changes in hormonal levels (during pregnancy, for example).

These are not all possible causes of gum disease, but most patient visits have one (or several) of these factors predisposing to inflammation in the gums.

Constant trauma (from food, the edge of a crown, tartar), microbial toxins, and impaired blood flow in the gums lead to the development of an inflammatory process. Usually, pus as such is not visible, but during periods of exacerbation, noticeable suppuration often occurs from periodontal pockets or its accumulation in the thickness of the mucosa (this formation is called a periodontal abscess).

Symptoms of gingivitis (periodontitis) in the acute stage

Patients with this diagnosis complain of:

• pain in the gums near a group of teeth;
• redness of the gums, swelling, pain when touched;
• it hurts to brush your teeth and eat;
• pus (sometimes with bloody veins) is released from the periodontal pocket or from the fistula tract (a fistula can form if the pockets are very deep);
• with gingivitis, the teeth usually do not suffer, but with periodontitis, tooth mobility, exposure of roots, pain from cold and sweet foods may be observed (since the root is more sensitive to irritants than the crown part of the tooth);
• Sometimes there is a deterioration in general health: fever, weakness, headache.

Exacerbations most often occur against the background of a general decrease in immunity (with acute respiratory infections or other diseases). In addition, periodontitis is characterized by seasonality (in spring and autumn, exacerbations occur more often).

Diagnostics

How to distinguish periodontitis from periodontitis? Outwardly, both cases may look the same: swollen gums, redness, a fistulous tract from which pus is released. In both cases, it hurts to bite on the teeth. In addition, one disease does not exclude another (there are cases when a tooth is surrounded by inflamed bone on all sides and it is almost impossible to say with certainty what is primary: periodontitis or periodontitis).

An x-ray is required to make a correct diagnosis and choose treatment tactics. In the image with gingivitis, we will not see any changes at all, but with periodontitis, areas where there is no bone tissue will be visible, while the teeth will be either healthy or well treated.

Treatment

It must be said right away that gingivitis is a reversible process, and periodontitis cannot be completely cured in most cases (it can be stopped, put into remission, but growing back the height of the bone is very problematic, and in many cases it is completely impossible).

If in the case of periodontitis we were dealing with microbes inside the root canal, then here we also have a microbial infection, only it is localized in the gums and bone. Treatment should be aimed at combating the cause, so the following measures can be taken:

• mandatory professional hygiene – removal of soft and hard dental plaque, polishing the surface of teeth, removal of granulations from periodontal pockets;
• correction of fillings and orthopedic structures, creation of normal contact points between teeth;
• if there is mobility of the teeth, they need to be splinted (limit movement);
• active anti-inflammatory therapy (rinses, dressings, ointments with antimicrobial action, in severe cases - antibiotics);
• general therapy (at the doctor’s discretion and depending on the severity of the process, antihistamines, painkillers, immunostimulants, vitamins, etc. can be added).

Usually this is enough to stop suppuration and relieve the acute process. To prevent exacerbations in the future, it is imperative to maintain hygiene (remove tartar at least once every six months), restore the dentition (if some teeth are missing), correct the bite (if there are problems with this) and maintain general health (if the cause of periodontitis is some common diseases).

Treatment of complex fistulas should be divided into 2 stages.

At the first stage, a drainage ligature is installed into the fistula tract - a thin, almost invisible suture material (Fig. 7). The main goals of this stage of treatment are: the formation of a direct fistula tract around the ligature, drainage of possible leaks, reduction of the inflammatory process, prevention of self-closure of the external opening for constant drainage of inflammatory and/or purulent discharge.

Figure 7. Drainage ligature

At the second stage, after the acute inflammation subsides (4-6 weeks), the main surgical treatment is performed - excision of the fistula.

Important! Two-stage surgical treatment provides conditions under which radical surgery becomes possible with minimal complications.

Currently, in the treatment of rectal fistulas, various biological materials based on connective tissue (Permacol), fibrin glue, and collagen paste are widely used, which are introduced into the fistula tract, tamponing it. These methods have a lesser effect on the rectal closure apparatus; their use does not lead to the formation of a massive wound defect. However, the rate of disease recurrence is significantly higher than radical surgery.

Promising modern methods for treating fistulas are endoscopic (VAAFT) and laser (FiLaC) technologies for removal of affected tissue. These technologies practically eliminate the possibility of damage to the sphincter apparatus, however, today, the effectiveness in leading clinics in the world does not exceed 50-60%.

Anesthesia and pain relief after surgery

The vast majority of surgical interventions for rectal fistulas are performed under subarachnoid or, as it is also called, spinal anesthesia. It refers to regional anesthesia methods that block the transmission of nerve impulses in a specific part of the body. A distinctive feature of any method of regional anesthesia is the minimum number of complications, in particular from the cardiovascular system, respiratory system, and brain. At the same time, you are conscious or, at your request, are in a superficial medicated sleep (sedation).

In the case of subarachnoid anesthesia during perineal surgery, the blockade of the nerve impulse occurs at the lumbosacral level. In our clinic, anesthesiologists and resuscitators prefer to perform a “saddle” block, which provides ideal anesthesia of the perineum with virtually no motor block, i.e. with preservation of motor function. If necessary, anesthesia can be supplemented with intravenous sedation. All this ensures maximum comfort for the patient and ideal working conditions for the surgeon.

If you are constantly taking a number of medications, for example, antihypertensives, those that affect blood clotting, or others, be sure to inform your anesthesiologist-resuscitator about this a few days before surgery.

Surgical interventions on the perineum can also be performed under general anesthesia.

After the operation, you will be prescribed pain relief as planned for several days, which can be easily done at home using tablets. These include local anesthetic drugs, intravenous analgesics and, in case of severe pain, potent drugs.

How to behave after surgery?

After the operation, you will remain in the hospital for 1 to 5 days, depending on the complexity of the operation. You will be prescribed, if necessary, antibacterial therapy and dressings with wound-healing ointments will be performed. After surgery, you may need to hold stool to allow the wound to heal.

Your doctor will teach you how to care for the wound, and it is extremely important to follow these recommendations strictly. One of the important recommendations is to irrigate the wound with a stream of water 3-4 times a day for the purpose of mechanical cleaning and periodic medical monitoring of proper healing in the direction “from the bottom of the wound.” After training, as a rule, you will be able to perform dressings yourself at home.

Stages of boil development and symptoms

As the boil matures, it sequentially goes through 3 stages of development. Each of them is characterized by a specific clinical picture.

The first is the infiltration stage . After staphylococcus enters the hair follicle, inflammation gradually develops in a small limited area. The affected area turns red, hardens and swells.

At the second stage - suppuration and necrosis - the focus of inflammation increases to several centimeters in diameter. Pain in the affected tissue appears, increasing with palpation.

, the purulent-necrotic stage develops . A small, raised, cone-shaped pustule forms in the center of the infiltrate. A necrotic core of pus and dead cells forms inside the abscess. The process is often accompanied by intoxication fever, general weakness and severe pain.

After some time, the pustule bursts, pus flows out of it and the necrotic core comes off. Swelling subsides, pain subsides. The patient's condition is improving.

The last stage is healing . After cleansing the wound, a deep cavity remains at the site of the infiltration. Gradually it fills with granulation tissue. The skin is restored. Scars form in place of extensive boils.

What complications can there be after surgery?

Currently, with the availability of standardized technology and an integrated approach to the diagnosis and treatment of rectal fistulas, unpleasant consequences are minimized. However, it should be noted that the risk of complications always exists.

The most serious complication after surgery for rectal fistulas is the development of anal incontinence. The risk of its occurrence is especially high during repeated interventions, when the anatomy is significantly changed and the holding function may be initially compromised. It is worth noting that when operations are performed by an experienced specialist who performs this type of intervention on an ongoing basis, the risk of incontinence is practically absent.

In addition, bleeding may develop both in the early postoperative period and several days after surgery. The nature and severity of the complication are determined only after examination. Stopping bleeding is usually possible in a dressing room. In some cases, repeat surgery may be required.

In addition, when treating complex and recurrent fistulas, due to pronounced scar changes, the sutures fixing the mucomuscular flap may diverge, which leads to inflammation in the wound and requires repeated interventions.

Opening abscesses at the Miracle Doctor clinic in Moscow

• Safe
  All procedures in the clinic are performed by experienced surgeons under sterile conditions.
• Painless
  Opening and drainage of the abscess is performed on the day of treatment under local anesthesia.
• Effective
  If you follow the doctor’s recommendations, the inflammatory process goes away quickly.

Causes of abscesses

• damage to the skin (pricks, scratches, abrasions);
• inflammatory diseases of the skin and subcutaneous tissue (carbuncles, boils);
• exposure of the skin to aggressive chemicals that cause its death (acids, alkalis);
• carrying out therapeutic injections in violation of hygiene rules, etc.

Symptoms of an abscess and indications for its removal

The main sign of a purulent inflammatory process is the appearance of a painful lump under the skin. The pain intensifies when pressing on the affected area. Gradually, this area may turn red and increase in size up to several centimeters. After a few days, the lump will become soft and a white or yellow abscess will form in its center. At this stage, patients’ general health deteriorates: body temperature rises (sometimes up to 40 ºС), headache and general weakness occur - general intoxication of the body begins.

You cannot wait for the abscess to go away on its own, since in each person the inflammatory process can occur with varying intensity and lead to dangerous consequences. Prices for opening abscesses are affordable for all patients, so you should not waste time and risk your health.

It is imperative to contact a medical facility if:

• new foci of inflammation form next to the abscess;
• localization of inflammation - the area of ​​the nasolabial triangle, spine or buttocks;
• ulcers appear in patients with diabetes.

What is the likelihood of the disease returning?

The risk of disease relapse with complex, high fistulas is slightly higher than with simple intrasphincteric fistulas and depends on the type of fistula, its location, and the presence of previous surgical interventions. Treatment of recurrent fistulas is a particularly difficult task for a coloproctologist. Previous operations on the anal canal create gross cicatricial deformities, changing the anatomy and significantly impairing the function of retention, and a long course of the disease or inadequate previous treatment can lead to the formation of additional streaks and passages. In such conditions, planning of surgical intervention should be carried out after a full examination.

The success of the upcoming surgical intervention largely depends on a comprehensive assessment of the available data using various diagnostic methods and a mandatory conversation with the surgeon. An important factor is also the implementation of surgical intervention in a specialized hospital, where this type of treatment is based on world research data, their own many years of experience and is carried out by specialists who have successfully completed training and courses to improve their skills in treating this disease.

Important! The skill of a coloproctologist is judged all over the world by the ability to correctly operate anorectal fistulas, since since the existence of proctology, the treatment of fistulas has been and is now perhaps the most difficult section of diseases of the anorectal zone!

The correct treatment for most boils is surgery.

Self-medication with ichthyol, Vishnevsky ointment, compresses can provoke uncontrolled spread and generalization of the purulent process, therefore only a doctor determines the treatment tactics for a boil. If the abscess is not properly opened and drained, antibiotics, anti-inflammatory and other drugs cannot effectively act on the tissue affected by pus.

Opening and draining the boil

If the purulent process extends beyond the hair follicle, mandatory surgical intervention is required. It is performed using classical techniques or using a laser. Laser removal of a boil is accompanied by additional disinfection of the affected tissues of the boil. The most optimal intervention technique in each specific clinical case is determined by the doctor.

The surgeon also determines the time for opening in such a way that the rod is fully formed - otherwise a relapse of the disease is possible. The procedure is performed under local anesthesia. After opening, pus and necrosis are removed. Drainage is removed according to indications. The tissues are treated with an antiseptic. An antibiotic ointment and a sterile dressing are applied to the wound.

Why do you choose us?

Part of the Perm State Medical University named after. I.M. Sechenova Clinic of Coloproctology and Minimally Invasive Surgery is an example of a new generation of medicine, harmoniously combining the deepest fundamental knowledge, honed skills, a modern multidisciplinary approach and attentive attitude to any category of patients.

KKMH is a guarantee that the surgical interventions performed within our walls correspond to the most current ideas about colorectal surgery. This includes our own department of anesthesiology and intensive care, whose employees ensure a smooth course of the operation and the early postoperative period and treat seriously ill patients. This is an “open intensive care unit”, where you can not only find out the most complete information about the condition of a loved one, but also be with him during a difficult time for him.

The doors of our Clinic are open to patients who were denied treatment in other hospitals due to the complexity of the surgical intervention or the neglect of the process. Elderly patients, patients with a “bouquet” of concomitant diseases (so-called comorbid) are an area of ​​our special interest. The presence in the hospital of such highly professional specialists as a cardiologist, pulmonologist, urologist, etc. allows us to treat patients of any age and with any concomitant diseases.

KKMH is a dynamically developing team of specialists who sincerely and deeply love their work, who are continuously learning and teaching others, who are interested in keeping you healthy.

Technique for opening a purulent abscess

Diagnostics To determine an abscess, the doctor only needs to examine the patient externally. The surgeon examines the area of ​​inflammation and decides on the need to open it and drain it.

Carrying out outpatient surgery. The doctor disinfects the site of inflammation and treats it with an anesthetic; if necessary, gives several painkiller injections around the abscess. After this, a small incision is made above the swelling, through which the purulent contents are removed. The opened cavity is washed and drained using special materials. The incision site is covered with a sterile gauze bandage.

Recovery period. The doctor provides the patient with recommendations regarding further treatment, changing bandages, and observing personal hygiene rules. Depending on the severity of the inflammatory process, a specialist may prescribe antibiotics. After 1–2 days, the patient needs to visit the doctor again to have the drain removed. If you follow the doctor's recommendations, the incision will heal completely within 2-3 weeks.

FAQ

Is it possible to cure a subcutaneous abscess without surgery?
If the patient began taking antibiotics in a timely manner and does not have complications in the form of intoxication of the body, then this is possible. In any case, such treatment must be carried out under the supervision of a doctor to prevent complications.

Is there a chance that I will be admitted to hospital due to an abscess?

In most cases, abscess opening is performed on an outpatient basis, with the patient returning home immediately after the procedure. At the same time, there are situations when people come to us with advanced pathology and complications. If the doctor comes to the conclusion that the patient requires treatment in a hospital (for example, due to a deep-seated abscess, the development of phlegmon, lymphangitis, etc.), then we can offer this option.

Is it true that patients with diabetes require hospitalization when abscesses appear?

Yes it's true. In patients with this diagnosis, purulent processes in the body tend to progress very quickly and spread to surrounding tissues. For this reason, diabetes mellitus requires hospital treatment. The patient will be discharged as soon as the blood glucose level has stabilized and the threat of complications has been eliminated.

Will there be a scar after removing the abscess?

This depends on the individual characteristics of the patient’s body, as well as on the scale and location of inflammation. The main goal of the procedure is to remove the purulent contents of the cavity in the tissues. For some, the inflammation may be minor, in which case a gentle incision is made, which leaves a slight mark on the skin. Someone comes to us with an advanced abscess, and then more extensive intervention may be required.