Current approaches to the diagnosis and treatment of acute paraproctitis (literature review)

Acute paraproctitis is a clinically significant suppurative inflammatory lesion of the pararectal tissue that requires timely diagnosis, adequate surgical drainage, and follow-up because of the risk of recurrence and anal fistula formation. The purpose of this study was to summarise current literature on the aetiology, pathogenesis, classification, diagnosis, surgical treatment, and postoperative management of patients with acute paraproctitis. A narrative literature review with elements of comparative analysis was carried out. The review established that acute paraproctitis most often develops as a manifestation of cryptoglandular infection, with polymicrobial flora and spread of pus into the perianal, intersphincteric, ischioanal, or supralevator space. For a typical superficial abscess, clinical inspection and digital rectal examination are sufficient, whereas recurrent, deep, and Crohn-associated forms require magnetic resonance imaging or endoanal ultrasonography. Timely incision and drainage remain the basic method of treatment. Primary fistulotomy was justified only for a clearly verified low fistula, whereas complex forms required a staged approach, with possible use of a draining seton. According to the reviewed sources, the rate of fistula formation after drainage was 23.0-33.9%, and, in a randomised study, omission of packing reduced pain from 38.2 to 28.2 points without a statistically significant increase in fistula or recurrence rates. Antibiotic therapy had selective value in systemic infection, cellulitis, immunosuppression, or diabetes mellitus. The optimal management strategy should be stratified according to anatomical form, fistula risk, systemic manifestations, and comorbid background. The practical significance of the study lies in substantiating a stratified algorithm for managing patients with acute paraproctitis, which differentiates simple and complex forms of the disease, identifies the need for imaging, antibacterial therapy, and staged surgical treatment in due time, and accounts for the risk of recurrence and anal fistula formation