THE PURPOSE

Study of the informativeness of clinical, laboratory and instrumental research methods in the early diagnosis of acute retrorectal paraproctitis (ARP).

MATERIAL AND METHODS

The prevalence of ARP among 548 patients with various forms of acute paraproctitis was analyzed, which was 69 (10.6%). The prevalence of ARR was also analyzed depending on the age and sex of patients, body type and body mass index (BMI), shape and location of the coccygeal bone, and the duration of hospitalization. The informativeness of clinical, laboratory and instrumental research methods in patients with ARP has been studied. The risk factors for the development of complications in patients with late diagnosis of the disease have been determined.

RESULTS

Based on the study of the clinical picture of various forms of the disease, a clinical classification of ARP has been developed. According to the proposed classification, a low form of ARP was found in 20 (27.5%) patients, an medium form in 27 (39.1%) and a high form in 22 (33.4%). The ratio of men and women was 4:1 in patients with ARP; high prevalence was found among middle-aged people (44.9%). Most often, ARP occurred in persons with mesomorphic and brachymorphic body types (88.4%) and overweight (36.2%). ARP was relatively often detected in patients with a normal location of the coccygeal bone (52.7%). The most difficult to diagnose forms of ARP were found in patients with a hook-shape disposition of coccygeal bone. The clinical symptoms of the disease are most informative in patients with a low form of the disease, and the indicators of laboratory research methods are most informative in patients with a high form of ARP. Instrumental research methods, in particular ultrasound, are considered the most informative for the small size of the abscess and the unexpressed clinical picture of the disease. The reasons for the late diagnosis of ARP are the topographic and anatomical features of the retrorectal space, the late appealability of patients, the features of the clinical manifestation of the disease and the methods of research in this area. Obesity and diabetes mellitus, localization of the purulent process in the upper floor of the retrorectal space, the hook-shaped form of the coccygeal bone and the brachymorphic body type are risk factors for the development of complications of ARP. In a microbiological study of purulent discharge in patients with ARP, the mixed microbial flora was detected more often than monoculture. Aerobic infection — mainly E. coli (75.9%) and St. aureus (64.8%) — more often detected in low and medium forms of ARP, anaerobic infection — in high form of the disease.

CONCLUSION

Determination of C-reactive protein in blood plasma and ultrasound are highly informative methods for early diagnosis of ARP. To assess the severity of the purulent-inflammatory process in ARP, the most informative research method is laboratory parameters of blood tests (C-reactive protein in blood plasma). Clinical research methods are informative in patients with a pronounced clinical picture of the disease and a low form of ARP.