Necrotizing paraproctitis in a 5-year-old child: a case report

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 Children’s 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.