The diagnosis of chronic paraproctitis and adrectal fistula is not particularly complex. First of all, the patients themselves have complained of the presence of pus in the perineal area (not everyone makes a complaint in this case the presence of the fistula).
First of all, a doctor conducts an external examination of the perianal region and perineum - the area where there may be external opening. In the case where there is an incomplete internal fistula adrectal, outer openings do not exist.
Before examining the patient's physician collects complaints and history, that is, figuring out how the disease began, how it proceeded, which was treated, if carried out.
Data on the number of patients, and fistulas and characterization may help in the diagnosis of other diseases of the rectum, which may also exhibit fistulas, such as actinomycosis, teratoidnye education, etc. The doctor also finds out about what the function of the intestine and the anal sphincter.
Before the external inspection of the patient is usually performed enema. Inspection is carried out with the patient on his side with those given to the abdomen or legs in the knee-elbow position. The doctor evaluates the condition of the skin of the perineum, fistula itself, how far it is from the anus.
Fistulas characteristic of acute myocardial paraproctitis, are usually solitary. Multiple fistulae adrectal characterized more for specific inflammation.
We estimate the nature of the discharge from the fistula, and their number. If the pressure in the fistula area has plenty of pus, it may indicate the presence of a fistula in the course of the cavity.
When specific types of fistulas adrectal selection are somewhat different. In tuberculosis discharge from fistula abundant. For actinomycosis is characterized by more meager selection, sinus openings is thus not one but several. Such moves are usually well palpated under the skin of the perineum with his finger, the skin around the external openings of fistula is a bluish tint.
Malignancy fistula is quite rare. Allocation for malignant degeneration adrectal fistula is usually bloody with mucus.
In addition, the physician assesses the state of the anal sphincter, as well as checking the reflex of the perianal skin, and reflexes kremasternyh paint strokes with a sharp object on the skin (mild or probe tip). This is done before palpation and digital examination of the rectum.
Palpation - feeling out of it. Palpation of the perianal area (the area around the anus) and the perineum allows the physician to assess the degree of rumen fistula during the process. Thus, we can identify the location of the fistulous intrasfinkterno, that is, when a fistula is a part of the anal sphincter.
Digital rectal examination - the most important method for diagnosis of diseases of the rectum. It allows you to evaluate the tone of the sphincter of the rectum. In protracted course of chronic paraproctitis and after an operative interventions on the rectum is often develops anal sphincter insufficiency. Digital rectal examination to determine the location of the internal fistula opening. Usually it is located in one of the anal crypts.
Depending on the location of the internal fistula opening, they may be: back, front, the side.
The most common rear adrectal fistula.
Work is also bimanual examination: palpation of the fistulous simultaneously from the rectum and perineum.
Digital rectal examination can also detect other diseases of the rectum (hemorrhoids, etc.), and prostate (in men).
For reliable detection adrectal fistula and its type (full or partial) conducted a test with dye. It is held, without exception, all patients with fistula. Usually it is used a solution of methylene blue or green fodder. In some cases, the dye is added to hydrogen peroxide, to ensure that staining fistulous under pressure, which gives a greater effect on the sample. The essence of the test lies in the fact that the doctor inserts a thin catheter with a syringe on the dye. If a patient has a complete fistula, that is, there is a complete report of the lumen surface of the perineum and rectum, is introduced into the rectum tupfer will be painted. This means that the fistula is completely connects the lumen of the rectum and the surface of the perineum.
The absence of such staining tupfera says there is no relationship between the surface of the perineum and rectum, that is, there is a part-time external fistula.
Another method of diagnosis adrectal fistula - sounding. This method allows the physician to assess the direction, that is the very course of the fistula, the presence of a fistula in the course of purulent "pockets" and the relationship of the fistula with sphincter. Commonly used a thin metal probe. He gently introduced into the fistulous opening, and then the doctor pushing it along the fistula by monitoring the progress of his index finger, which is introduced into the patient's rectum. If the fistulous course is short and straight, then the probe can easily fall into the lumen of the rectum. If the tortuous course of the fistula, the probe does not penetrate into the rectum.
Sigmoidoscopy performed in all patients with rectal. It allows the doctor to clearly see and assess the condition of the rectal mucosa, as well as identify other concomitant of the disease (cancer, inflammatory diseases, hemorrhoids, etc.).
If the doctor suspects a patient or a trans-ekstrasfinkterny fistula, such method is carried out as fistulografiya. This radiological method of study, and consists in carrying out the patient barium enema, and thereafter radiography.
In addition to all these methods is also used ultrasound.
Differential diagnosis of fistula adrectal
Fistulas of the rectum may occur in other diseases, such as cysts adrectal fiber, osteomyelitis (inflammation of bone tissue) of the sacrum, or tailbone. In addition, adrectal fistulas may occur during actinomycosis, tuberculosis, Crohn's disease, the course of epithelial coccygeal.
Cyst adrectal fiber (eg, teratoma) can often fester. Draining a cyst comes out. As a result, perianal fistula is formed. Such a fistula and should be distinguished from paraproctitis.
When adrectal cyst doctor can detect it and test the circular formation of a dense consistency. In a sample of paint with such a fistula in the rectum of the paint is not detected. However, such a festering cyst may reveal both the skin of the perineum and into the lumen of the rectum. In this case, there is a complete fistula. Great help in the diagnosis of ultrasound has adrectal cellular spaces.
Another reason for the fistula may be osteomyelitis of pelvic bones. In contrast, chronic paraproctitis, chronic osteomyelitis, there is some external sinus openings. They are usually located far from the anus, and in no way related to the intestinal lumen. To clarify the diagnosis is carried out X-ray of the pelvis and spine.
For a typical actinomycosis multiple fistulas. In addition, the skin in their circle usually with a bluish tint, and the fistulous passages can be long and well palpated under the skin of the perineum. A sample of paint does not reveal the fistula connection with the lumen of the rectum. Discharge from the fistula with actinomycosis is usually scanty, sometimes kroshkovidnye.
In tuberculosis of the intestine may also be rectal fistula. In this case, for tuberculosis is characterized by copious pus. Diagnosis confirmed by microscopic examination of purulent discharge.
In Crohn's disease can also be fistulae. They are the main complication of the disease. The difference from adrectal fistula is that Crohn's disease there are sores, fractures, and fistula adrectal with inflammation in the rectal mucosa is minimal.
Sometimes fistulas of the rectum should be distinguished from fistula associated with suppuration of epithelial coccygeal, mainly in the case where such a course opens near the anus. What distinguishes them is the lack of communication with the lumen of the fistula of the rectum.
Malignant degeneration of fistulas of the rectum is very rare. A characteristic feature in this case are spotting with mucus. The most important method of diagnosis in this case is a cytological study of scrapings from the fistulous.