PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF PARAPROCTITIS IN CHILDREN

Abstract

Relevance. Children with acute and chronic paraproctitis constitute 1-3% of hospitalized subjects with purulent surgical infection. Purpose. To study specific features of paraproctitis in children and to analyze outcomes of treatment. Material and methods. Case-histories of 218 children with acute and chronic paraproctitis were analyzed. Microbiological culture for pathogen identification was taken from paraproctitis focus, breast milk, from feces for conditionally pathogenic flora. The researchers also studied anamnesis, type of feeding, results of ultrasound examination of the perianal area and histological test of the material taken during surgery. Results. Patients with subcutaneous and subcutaneous-submucous paraproctitis constituted 95.5% [1]. The majority of patients with subcutaneous and subcutaneous-submucous paraproctitis - up to 62,5% - were children of the first 6 months of their life. The researchers defined age and etiopathogenic aspects of paraproctitis in children; the impact of provoking factors at acute paraproctitis as well as the specificity of chronic paraprocitis course and its treatment. 76 patients with acute paraproctitis had bottle and mixed feeding for the first 6 months of their life with further developed intestinal dysbiosis. In 112 children, conditionally pathogenic microorganisms were identified in 91 (81,2%) at the first year of their life. Ultrasound examination was sensitive for acute and chronic paraproctitis in about 90% [2, 3]. With the developed intestinal dysbiosis and immunological features of children at their first year of life , the process of acute paraproctitis was caused by the causal anal crypt and abnormal ducts of anal glands. It is considered to be the first step in fistula formation (fistulous abscess) [4-6]. The Gabriel surgery performed in acute paraproctitis was pathogenically verified because due to it one of the pathogenic steps was erradicated- pararectal fistula formation [7-11]. Disease relapse (pararectal fistula) was met in 7 patients. In average, hospitalization lasted for 7.1 days in acute paraproctitis and 8.4 in chronic paraproctitis. Conclusion. On analyzing etiopahogenic features of acute subcutaneous and subcutaneous-submucous paraproctitis, the authors recommend to perform a one-step surgical intervention.