Proctology

Cryptic

The cryptic is an inflammation of morganeve crypts (acute or chronic).

Causes

The contact with intestinal contents into the crypts — the phenomenon absolutely normal, it is usually well emptied, and if the ducts of the anal glands are passable, their secret helps to create a barrier to the penetration of microbial flora into the deeper layers. In some cases, the normal process may be disrupted. This causes most trauma to the walls of the crypt of the solid components of feces (the seeds, rind, seeds, pieces of bran, bristles, etc.), poor drainage of the crypts (because of the contamination of the solid lumps, swelling of the mucous membrane in diarrhoea), as well as obstruction of the ducts of the anal glands. So any violation of the process of emptying the rectum, any most minimal trauma can lead to inflammatory changes in the crypts, and the disruption of the anal glands, blockage of the lumen of the inflammatory process may spread to the deeper layers of the intestinal wall and cause abscess.

Symptoms, clinical course

Criptica the main manifestations are a pain in the anus, aggravated by defecation, and discomfort, sometimes marked burning, foreign body sensation in the rectum. The appearance of blood in the form of admixtures in feces, too often. In the presence of purulent secretions is marked itching of the perianal area. The increase in body temperature, as a rule, not marked.

If in the acute period is eliminated a factor that led to the emergence of disease — established the drainage of the crypts and anal glands — recovery occurs. In some cases, the inflammatory process may extend into adjacent crypts and overlying the rectum. Most of the process flows in waves: inflammation in the crypt abates, but under unfavorable conditions repeated.

Complications

If granted independently or under the influence of conservative treatment crypts abscess is not opened into the lumen of the colon, the inflammatory process may extend into adjacent crypts, does not exclude the possibility of purulent proctitis, but often cryptic complicated by spread of infection into with the release of the cellular spaces of space, which is regarded as acute abscess.

In cases where crypts abscess emptied into the lumen of the intestine, but the drainage is insufficient or is not resolved the factors that led to the emergence of criptica (constipation, microtrauma due to prolonged straining, fissures, large hemorrhoids that violate the drainage of the crypts, etc.), inflammation in the crypt becomes chronic with periods of exacerbations. This can lead to cicatricial deformation of the crypts, to the formation of incomplete internal fistula of the rectum. When the spread of inflammation to neighboring crypts in some cases chronic inflammatory process leads to productive and then in the upper third of the anal canal, where is the bottom of the crypts, produce dense scar tissue — pectines. In marked pectinase when the rumen has a length of more than a quarter of the circumference of the anal canal, reduced tissue elasticity and ability to stretch during the passage of the fecal bolus, which leads to disruption of the emptying of the rectum.

Diagnostics

After ascertaining the patient’s complaints, evaluating the General condition is carried out an external examination of the perineal region, palpation of the perianal area, careful finger examination of the anal canal region of the crypts and the distal part of the rectum, ANO – and sigmoidoscopy. It is obligatory medical examination of the patient. If necessary, the study can be complemented by ultrasound (rectal probe), proctography, biopsy (suspected malignancy).

If the process is limited only by the crypt, at external examination of the anus, usually changes are noted. When digital examination of the walls of the anal canal in the upper one third and palpation in the region of the crypt, revealed local tenderness and pasty. The survey through anoscope allows in some cases to detect swelling and hyperemia in the region of the crypts, fibrin, sometimes with pressure from crypts can stand a drop of pus. Sometimes when anoscopy can see on the background of hyperemia, bright red dot, which corresponds to the excretory ducts of the anal glands. Unfortunately, in recto – and anoscopy not always possible to see the bottom of the crypts.

Sigmoidoscopy allows to assess the condition of the mucous membrane of the rectum and distal sigmoid colon and to exclude other possible causes pain and abnormal discharge from the anus.

Differential diagnosis. In the acute phase and during exacerbations of the chronic course cryptic have to be differentiated from an acute abscess (often intramuscular). For this, conduct a thorough digital examination of the walls of the anal canal and region of the crypts, palpation of the walls at the level of the crypts between two fingers — the index in the large intestine and the skin. Infiltration of tissues deeper within the crypt, the evidence in favor of abscess, and purulent discharge from the anus in the form of droplets upon dilution perianal skin, most often on the presence of incomplete internal fistula of the rectum.

Treatment

Uncomplicated cryptic treated conservatively. Assigned diet with the exception of salty, spicy, alcohol. Food should be large enough to avoid delays of the chair, lean and with good cooking. Laxatives should not be consumed, constipation is better to clean the rectum with an enema. The consumption of laxatives leads to the dilution of the intestinal contents, managementnow the act of defecation, which contributes to irritation and swelling of the mucous membrane of the rectum.

You must carefully perform hygienic measures: sitz baths with laboratofy potassium permanganate solution with water temperature 37-38 °C for 10-15 min, the obligatory cleaning of the anus after a bowel movement and at night for 7-10 days 30-40 ml microclysters with 0.3% solution of collargol. Assigned rectal suppositories.

With the failure of conservative treatment is usually there are complications in the form of acute abscess is formed or incomplete fistula of the rectum. In either case, treatment is surgical.

The prognosis of acute griptite in case of an empty crypts abscess in the lumen of the intestine is favorable. It is important then eliminating all factors causing repeated inflammation or the transition of acute to chronic. The need for timely and properly conducted treatment of acute criptica emphasize such statements: “the source of almost all infectious diseases perianal and anorectal area is affected crypt”, cryptic might be called “the greatest little disease in proctology”.

Reviewed by the QSota Medical Advisory Board