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ΠΠ½ΠΎΠΉΠ½ΠΎ-Π½Π΅ΠΊΡΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΠ°ΡΠ°ΠΏΡΠΎΠΊΡΠΈΡ Ρ ΡΠ΅Π±Π΅Π½ΠΊΠ° 5 Π»Π΅Ρ: ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅
Authors present a rare clinical case of successful treatment of a 5-year-old child with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency state.
Clinical case. A 5-year-old boy became acutely ill, against the background of diarrhea with hyperthermia. An area of hyperemia, edema, and tissue infiltration appeared in the perianal region. In anamnesis, with frequent respiratory infections and dysfunction of the intestinal tract in the form of diarrhea. He was admitted to the Regional Childrens Hospital on the 10th day of illness from the regional hospital, where antibiotic treatment was started. Upon admission, the condition was serious in the perianal region with an extensive wound necrotic tissues and a plaque of fibrin. To create favorable conditions for wound healing, a preventive sigmostomy operation was performed. Multidrug-resistant Pseudomonas aeruginosa was found in the wound culture. Thus, courses of antibiotics treatment, infusion therapy, and surgical debridement of the perianal wound and its local treatment were performed. Upon immunological status examination, a primary immunodeficiency was revealed, for which drugs with immunoglobulin G were administered. As a result of the treatment, the wound healed by secondary intention, thus, an operation was performed to close the sigmostoma. The child was discharged in satisfactory condition under the supervision of an immunologist and a surgeon.
Discussion. In this case, preventive sigmostomy is justified; however, authors limit themselves to surgical intervention on the perineum in other cases. Pseudomonas aeruginosa shows its pathogenicity in patients with impaired immunity. Therefore, courses of antibiotics, infusion therapy, and immunomodulatory therapy along with surgical treatment, favorable result were achieved.
Conclusion. Children with purulent-necrotic paraproctitis, which developed against the background of a primary immune deficiency should be hospitalized as early as possible in a specialized hospital.ΠΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΎ ΡΠ΅Π΄ΠΊΠΎΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΡΡΠΏΠ΅ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ΅Π±Π΅Π½ΠΊΠ° 5 Π»Π΅Ρ Ρ Π³Π½ΠΎΠΉΠ½ΠΎ-Π½Π΅ΠΊΡΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ°ΡΠ°ΠΏΡΠΎΠΊΡΠΈΡΠΎΠΌ, ΡΠ°Π·Π²ΠΈΠ²ΡΠΈΠΌΡΡ Π½Π° ΡΠΎΠ½Π΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ ΠΈΠΌΠΌΡΠ½ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ.
ΠΠΏΠΈΡΠ°Π½ΠΈΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. ΠΠ°Π»ΡΡΠΈΠΊ, 5 Π»Π΅Ρ, Π·Π°Π±ΠΎΠ»Π΅Π» ΠΎΡΡΡΠΎ, ΠΊΠΎΠ³Π΄Π° Π½Π° ΡΠΎΠ½Π΅ Π΄ΠΈΠ°ΡΠ΅ΠΈ Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅ΡΠΌΠΈΠ΅ΠΉ Π² ΠΏΠ΅ΡΠΈΠ°Π½Π°Π»ΡΠ½ΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ ΠΏΠΎΡΠ²ΠΈΠ»ΡΡ ΡΡΠ°ΡΡΠΎΠΊ Π³ΠΈΠΏΠ΅ΡΠ΅ΠΌΠΈΠΈ, ΠΎΡΠ΅ΠΊΠ° ΠΈ ΠΈΠ½ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ ΡΠΊΠ°Π½Π΅ΠΉ. Π Π°Π½Π°ΠΌΠ½Π΅Π·Π΅: ΡΠ°ΡΡΡΠ΅ ΡΠ΅ΡΠΏΠΈΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΈ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ ΠΊΠΈΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ° Π² Π²ΠΈΠ΄Π΅ Π΄ΠΈΠ°ΡΠ΅ΠΈ. ΠΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½ Π² ΠΠ±Π»Π°ΡΡΠ½ΡΡ Π΄Π΅ΡΡΠΊΡΡ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ Π½Π° 10-Π΅ ΡΡΡΠΊΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΈΠ· ΡΠ°ΠΉΠΎΠ½Π½ΠΎΠΉ Π±ΠΎΠ»ΡΠ½ΠΈΡΡ, Π³Π΄Π΅ Π±ΡΠ»ΠΎ Π½Π°ΡΠ°ΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊΠ°ΠΌΠΈ. ΠΡΠΈ ΠΏΠΎΡΡΡΠΏΠ»Π΅Π½ΠΈΠΈ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΡΡΠΆΠ΅Π»ΠΎΠ΅, Π² ΠΏΠ΅ΡΠΈΠ°Π½Π°Π»ΡΠ½ΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ ΠΎΠ±ΡΠΈΡΠ½Π°Ρ ΡΠ°Π½Π° Ρ Π½Π΅ΠΊΡΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΡΠΊΠ°Π½ΡΠΌΠΈ ΠΈ Π½Π°Π»Π΅ΡΠΎΠΌ ΡΠΈΠ±ΡΠΈΠ½Π°. ΠΠ»Ρ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΡ
ΡΡΠ»ΠΎΠ²ΠΈΠΉ Π΄Π»Ρ Π·Π°ΠΆΠΈΠ²Π»Π΅Π½ΠΈΡ ΡΠ°Π½Ρ Π±ΡΠ»Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ ΠΏΡΠ΅Π²Π΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠΈΠ³ΠΌΠΎΡΡΠΎΠΌΠΈΠΈ. Π ΠΏΠΎΡΠ΅Π²Π΅ ΠΈΠ· ΡΠ°Π½Ρ ΠΎΠ±Π½Π°ΡΡΠΆΠ΅Π½Π° ΠΏΠΎΠ»ΠΈΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½Π°Ρ Pseudomonas aeruginosa. ΠΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΊΡΡΡΠ°ΠΌΠΈ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊΠΎΠ², ΠΈΠ½ΡΡΠ·ΠΈΠΎΠ½Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ, Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΠ±ΡΠ°Π±ΠΎΡΠΊΠ° ΡΠ°Π½Ρ ΠΏΠ΅ΡΠΈΠ°Π½Π°Π»ΡΠ½ΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ ΠΈ ΠΌΠ΅ΡΡΠ½ΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° Π²ΡΡΠ²Π»Π΅Π½ΠΎ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ΅ ΠΈΠΌΠΌΡΠ½ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠ½ΠΎΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅, ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π²Π²ΠΎΠ΄ΠΈΠ»ΠΈΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ Ρ ΠΈΠΌΠΌΡΠ½ΠΎΠ³Π»ΠΎΠ±ΡΠ»ΠΈΠ½ΠΎΠΌ G. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠ°Π½Π° Π·Π°ΠΆΠΈΠ»Π° Π²ΡΠΎΡΠΈΡΠ½ΡΠΌ Π½Π°ΡΡΠΆΠ΅Π½ΠΈΠ΅ΠΌ, ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π° ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡ Π·Π°ΠΊΡΡΡΠΈΡ ΡΠΈΠ³ΠΌΠΎΡΡΠΎΠΌΡ. Π Π΅Π±Π΅Π½ΠΎΠΊ Π²ΡΠΏΠΈΡΠ°Π½ Π² ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌ ΡΠΎΡΡΠΎΡΠ½ΠΈΠΈ ΠΏΠΎΠ΄ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΈΠΌΠΌΡΠ½ΠΎΠ»ΠΎΠ³Π° ΠΈ Ρ
ΠΈΡΡΡΠ³Π°.
ΠΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. Π Π΄Π°Π½Π½ΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΠΎΠΏΡΠ°Π²Π΄Π°Π½ΠΎ ΠΏΡΠ΅Π²Π΅Π½ΡΠΈΠ²Π½ΠΎΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΡΠΈΠ³ΠΌΠΎΡΡΠΎΠΌΠΈΠΈ, Ρ
ΠΎΡΡ Π² Π΄ΡΡΠ³ΠΈΡ
Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡΡ
Π°Π²ΡΠΎΡΡ ΠΎΠ³ΡΠ°Π½ΠΈΡΠΈΠ²Π°Π»ΠΈΡΡ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²ΠΎΠΌ Π½Π° ΠΏΡΠΎΠΌΠ΅ΠΆΠ½ΠΎΡΡΠΈ. Pseudomonas aeruginosa ΠΏΡΠΎΡΠ²Π»ΡΠ΅Ρ ΡΠ²ΠΎΡ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π½ΠΎΡΡΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π°ΡΡΡΠ΅Π½ΠΈΡΠΌΠΈ ΠΈΠΌΠΌΡΠ½ΠΈΡΠ΅ΡΠ°. ΠΠΎΡΡΠΎΠΌΡ, Π½Π°ΡΡΠ΄Ρ Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ, ΠΊΡΡΡΠ°ΠΌΠΈ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊΠΎΠ², ΠΈΠ½ΡΡΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠ΅ΠΉ, ΡΠΎΠ»ΡΠΊΠΎ ΠΏΡΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ ΠΈΠΌΠΌΡΠ½ΠΎΠΌΠΎΠ΄ΡΠ»ΠΈΡΡΡΡΠ΅ΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±ΡΠ» Π΄ΠΎΡΡΠΈΠ³Π½ΡΡ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ.
ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠ΅ΡΠ΅ΠΉ Ρ Π³Π½ΠΎΠΉΠ½ΠΎ-Π½Π΅ΠΊΡΠΎΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ°ΡΠ°ΠΏΡΠΎΠΊΡΠΈΡΠΎΠΌ, ΡΠ°Π·Π²ΠΈΠ²ΡΠΈΠΌΡΡ Π½Π° ΡΠΎΠ½Π΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠ³ΠΎ ΠΈΠΌΠΌΡΠ½ΠΎΠ΄Π΅ΡΠΈΡΠΈΡΠ½ΠΎΠ³ΠΎ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΠΊΠ°ΠΊ ΠΌΠΎΠΆΠ½ΠΎ ΡΠ°Π½ΡΡΠ΅ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π² ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ ΡΡΠ°ΡΠΈΠΎΠ½Π°Ρ