Przetoki odbytu to nieprawidłowe połączenia między kanałem odbytu a skórą. Tworzą się w konsekwencji zakażenia rozprzestrzeniającego się z krypt i gruczołów odbytowych. Jakie wyróżnia się rodzaje przetok?
Biorąc pod uwagę przebieg przetok w stosunku do zewnętrznego zwieracza odbytu wyróżnia się 4 rodzaje przetok:
- międzyzwieraczowe – penetruje jedynie przez wewnętrzny zwieracz odbytu
- przezzwieraczowe – przechodzą przez zwieracze wewnętrzny i zewnętrzny
- nadzwieraczowe
- pozazwieraczowe – występują nierzadko w chorobie Leśniowskiego-Crohna czy w zapaleniu uchyłków. Przebiegają od zagięcia esiczo-prostniczego do skóry, bocznie w stosunku do mięśni zwieraczy odbytu.
Więcej niż 95 proc. wszystkich przetok w okolicy odbytu stanowią dwa pierwsze rodzaje przetok. U części pacjentów u których wystąpiły przetoki, odnotowano również wcześniej ropień odbytu. Ten natomiast samoistnie przebił się do skóry albo zdrenowano go.
Jakie są najczęstsze objawy przetok i jak się je leczy?
Charakterystycznym objawem przetok jest stały lub okresowy wyciek treści ropnej z otworu w skórze oraz często występujący ból w okolicy odbytu. Po tym, jak dojdzie do samoistnego zamknięcia zewnętrznego ujścia przetoki, u części pacjentów może dojść do zaostrzenia stanu zapalnego.
U pacjentów z przetoką odbytu leczenie polega na wycięciu lub rozcięciu przetok. Wówczas pozostawia się je do ziarninowania. Niezwykle istotne jest również namierzenie wewnętrznego otworu przetoki, który należy usunąć bądź zamknąć.
W przypadku wysokich przetok przezzwieraczowych i nadzwieraczowych w leczeniu stosuje się setom, czyli grubą niewchłanialną nić. Lekarz zakłada ją wokół mięśnia zwieracza zewnętrznego odbytu. Dzięki tej metodzie zaznaczony jest przebieg przetoki. Pozwala ona również na długotrwały drenaż.
Źródło: Bartnik W., Interna Szczeklika 2018, Medycyna Praktyczna, Kraków 2018, s. 1058
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