Cryptitis


Cryptitis

Description, Causes and Risk Factors:

ICD-10-DC: K62.8

Inflammation of a follicle or glandular tubule, particularly in the colon, anal, rectal.

Cryptitis is defined as an inflammatory process in the crypts, characterized by redness, swelling, and thickening of the tissues in this area. This condition is identified proctoscopically as a pearl of pus beading up from the crypt at the level of the dentate line. Cryptic infection often causes the dissolution of the roof of the crypt, resulting in anal fissure. An infected crypt that is chronic, and fails to un-roof, can develop into an anal abscess and/or fistula.

The cause of cryptitis may be due to an inflammatory process in the adjacent areas, or a disturbance in the acid pH balance of the rectum. Trauma from constipated stools, infections introduced from external sources, parasites, foreign debris, etc., may also initiate cryptitis.

Risk Factors:

    Inflammatory bowel disease.

  • Diverticular disease.

  • Infectious colitis.

  • Radiation colitis.

To elucidate clinical features of anal cryptitis, 102 patients were reviewed. There were 69 males and 33 females aged 14 to 85 years. Mild to moderate anal pain, usually not related to defecation, was the chief complaint and especially appeared when the patient was in the sitting position. The duration of the symptoms varied. Of the 102 subjects, 28 had a combined anal fissure, whereas no patients had a combined anal fistula.

cryptitis

The anal crypt with inflammation was deformed and compression pain was found on digital examination. Cryptitis occurred predominantly at the crypt located at the posterior wall of the anus. Histologically, lymphocyte infiltration without destruction of the anal gland was characteristic of cryptitis, indicating that the disease is a mild chronic inflammation. A conservative therapy with medication was a first choice of treatment. Cryptectomy was indicated in patients with an intractable disease.

In conclusion, anal cryptitis is a mild chronic inflammatory disease, rarely resulting in anal fistula or abscess. Although the pathogenesis is still unknown, anal cryptitis should be recognized as a clinical entity of anal diseases from both the clinical and pathological viewpoints.

Symptoms:

Cryptitis is held responsible for a variety of conditions and symptoms. The pain of cryptitis is usually of the sharp lancinating or burning variety. A dull ache or intense pain from spasm of the contraction of the sphincter muscle may develop from the inflammatory process. The nature of a crypt infection is of an ebb and flow, and may be of such a low grade that the pain is transitory.

Diagnosis:

This unusual condition is identified anoscopically as a pearl of pus beading up from the crypt at the level of the dentate line.Histologically, lymphocyte infiltration without destruction of the anal gland was characteristic of cryptitis, indicating that the disease is a mild chronic inflammation.

Treatment:

Surgical removal of a crypt is not the complete answer to treating cryptitis. The cause must be eliminated.

Cryptogenic abscess is an acute surgical emergency, and demands immediate operation. Delay only encourages the spread of infection, and the destruction of tissue. The drainage of the abscess, the removal of the infected crypt and gland and curettage/curettement of the communicating tract should always be carried out in one stage in the treatment of all types of acute cryptogenic abscess. The surgeon should be conservative, the sphincter need not be cut and adequate drainage of the superficial abscess requires only one or two simple radial incisions in the anal perineum with a minimum of saucerization. Cryptogenic abscess developing in the rectovaginal septum should never be drained through the vagina. All incisions for the drainage of abscesses in the superficial spaces should be radial to the anal canal. Deep cryptogenic abscesses which originate in the superficial spaces should be drained through these spaces and never through the rectum. Deep cryptogenic abscesses which do not originate in the superficial spaces should be drained through the rectum. When no communication with the bowel can be demonstrated, it is not wise to make one. However, deep or suspected crypts in the immediate area should be excised. The association of diarrhea with cryptogenic abscess is frequent. Therefore, the presence of this type of infection should lead one carefully to investigate the bowel for inflammatory and neoplastic disease. Idiopathic ulcerative colitis and other forms of dysentery are not contraindications to this form of surgical treatment of cryptogenic abscess. Associated disease which may interfere with healing should be removed at the time of the initial surgery. The use of sulfa or antibiotic drugs to avoid or delay surgery in the treatment of cryptogenic abscess is condemned. Their use leads to chronic abscess formation with increased destruction of tissue.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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