Paracolitis

PARACOLITIS, paracolitis (from Greek para- meaning near and colon- meaning colon), inflammation of the paracolic (retrocolic) space (see Retroperitoneal space). Most often the right side is affected, which is explained by its proximity to the cecum and the vermiform appendix. Previously (before 1909), most authors confused paracolitis with paranephritis (see) or retroperitoneal phlegmon. Based on his anatomical research, Stromberg identified the paracolic space as a separate area and suggested the possibility of an isolated inflammatory process within it. Fedorov proposed to identify paracolitis as a topographically independent process. It most often arises as a complication of appendicitis, mainly in retrocecal, and especially in retroperitoneal, position of the appendix; paracolitis can be a consequence of trauma, and sometimes occurs by metastatic means. Cases of paracolitis have been described resulting from perforation of the posterior (non-peritoneal-covered) wall of the intestine by a foreign body. Sizemsky found a nail in the pus of paracolitis, which had been swallowed by a child several days before the appearance of paracolitis symptoms. On the left side, paracolitis occurs as a complication of sigmoiditis. Rarely, paracolitis has a specific character, for example, syphilitic, usually in connection with gummas along the course of the large intestine. The clinical picture of paracolitis differs little from that of paranephritis, and it is easily confused with the latter. Distinctive signs may include the symptom of Petit's triangle, observed in appendicitis (see Appendicitis) and paracolitis, but absent in paranephritis. The truth is often revealed only during the opening of the abscess. The pus in paracolitis usually has a strong odor of intestinal contents and, in cultures, often yields abundant growth of bacillus coli. In paracolitis of appendicular origin, sometimes during the postoperative period, feces begins to be discharged from the wound. Without adequate therapy, the abscess, spreading, may extend beyond the paracolic space, destroying the fascial partitions that limit it. In such cases, the abscess, spreading along the perirenal tissue and textus cellulosus, may present a picture of diffuse retroperitoneal phlegmon (see Retroperitoneal space), and spreading higher, may lead to the development of a subphrenic abscess. - T r e a t m e n t - surgical: opening of the abscess by a posterior lumbar incision. If a connection is found between paracolitis and the inflamed vermiform appendix, the latter should be removed in a second stage, preferably after complete wound healing.