DOI: 10.25881/20728255_2022_17_2_61

Authors

Muravyov A.V.1, Zhuravel R.V.2, Muravyov K.A.2, Zhernosenko A.O.3, Zhernosenko S.O.3

1 The Stavropol State Medical University, Stavropol

2 The Stavropol clinical hospital №3, Stavropol

3 The Tuapse district hospital № 3, Tuapse

Abstract

The actinomycosis is a chronic specific infectious disease caused by a heterogeneous group of bacteria belonging to the orders Actinomycetales and Bifidobacteriales, characterized by damage to various organs and tissues with the formation of dense infiltrates and fistulas. In recent years, there has been an increase in the number of patients with this pathology, and treatment outside specialized institutions leads to almost 100% relapse of the disease. So far, it has not been possible to come to a consensus in approaches to the treatment of both actinomycosis in general and actinomycosis of the perianal and sacrococcygeal regions in particular.

Objective: to improve the results of treatment of patients with actinomycosis of the perianal and sacrococcygeal regions.

Materials and methods. The study included 74 patients with actinomycosis of the sacrococcygeal and perianal regions. The average age of the observed patients was 40-50 years. The ratio of men and women was approximately 10:1. There was a predominance of patients from rural areas — 63% of patients. All patients were divided into three groups. Patients of each group received different methods of treatment. Group I (n = 20) — exclusively surgical treatment was performed. Group II (n = 19) — patients received conservative treatment with actinolysate. Group III (n = 35) — combined treatment, which consisted of immunotherapy with polyoxidonium and radical surgical intervention. The clinical picture was evaluated, bacteriological, histological studies, a skin-allergic test with actinolysate were carried out.

Results. In group I, a relapse of the disease was detected in 3 (16.7%) patients, 4 (22.2%) patients were concerned about pain or discomfort in the area of surgery due to the formation of rough scars, or there was an insufficiency of the anal sphincter. In group II, there was some improvement in the form of a decrease in infiltrates and the amount of discharge from the fistula passages, but scarring and recovery did not occur, surgical intervention was required. In group III, 25 (89.3%) patients had no pain in the area of surgery, anal sphincter function did not suffer, only 1 (3.6%) had discomfort in the area of surgical treatment. Two patients (7.1%) reported acute paraproctitis a few months later, which was regarded as a relapse of the disease.

Conclusion. The proposed method of treatment allows us to achieve recovery in 92.9% of cases, get good functional results, reduces the total stay of patients in the hospital and reduces the total cost of their treatment.

Keywords: аctinomycosis, рerianal area, sacrococcygeal region, treatment, immunotherapy.

References

1. Asnin DI. Rasprostranenie i klinicheskie formy aktinomikoza. Sovetskaya medicina. 1953; 3: 95-96. (In Russ).

2. Bennett DE. Aktinomikoz. Vnutrennie bolezni. Harrison, editor. Moskva; 1994. (In Russ).

3. Mirzabalaeva AK, Kotrekhova LP, Aravijskij RA, et al. Klinicheskie varianty oslozhnennogo techeniya aktinomikoza. Uspekhi medicinskoj mikologii: sb. nauch. tr. Moskva; 2004: 250-252. (In Russ).

4. Suteev GO. Aktinomikoz. Moskva; 1951. (In Russ).

5. Murav’yov AV, Zhuravel’ RV, Halin DA, et al. Aktinomikoz krestcovo-kopchikovoj i perianal’noj oblastej. Koloproktologiya (nauchno-prakticheskij medicinskij zhurnal). 2008; 23(1): 19-23 (In Russ).

6. Acevedo F, Baudrand R, Letelier LM. Actinomycosis: a great pretender. Case reports of unusual presentations and a review of the literature. Int J. Infect Dis. 2007; 12: 43-48.

7. Bagdasaryan LK. Pararektal’nyj aktinomikoz. Uspekhi medicinskoj mikologii: sb. nauch. tr. Moskva; 2004: 244-245. (In Russ).

8. Murav’yov AV, ZHuravel’ RV, Murav’eva AA, et al. Kompleksnoe lechenie aktinomikoza krestcovo-kopchikovoj i perianal’noj oblastej. Medicinskij vestnik Severnogo Kavkaza. 2012; 25(1): 35-38. (In Russ).

9. Burova SA, Yаkobishvili YаI, Sakunova TI, et al. Hirurgicheskoe lechenie aktinomikoza. Uspekhi medicinskoj mikologii: sb. nauch. tr. Мoskva. 2004: 246-247. (In Russ).

10. Halin DA. Aktinomikoz krestcovo-kopchikovoj i perianal’noj oblastej. [Avtoreferat dissertation] Stavropol’; 2007. (In Russ).

For citation

Muravyov A.V., Zhuravel R.V., Muravyov K.A., Zhernosenko A.O., Zhernosenko S.O. The actinomycosis of the perianal and sacrococcygeal regions in surgery. Bulletin of Pirogov National Medical & Surgical Center. 2022;2(17):61-65. (In Russ.) https://doi.org/10.25881/20728255_2022_17_2_61