Cryptitis

Background

• Cryptitis is a/w repetitive sphincter trauma from spasm, recurrent diarrhea, or passage of large/hard stools.
• Pathophysiology
  • Anal crypts are mucosal pockets that lie between the columns of Morgagnia
    • Formed by the puckering action of the sphincter muscles
  • Superficial trauma (diarrhea, trauma from hard stool) → breakdown in mucosal lining
    • Bacteria enter, inflammation extends into lymphoid tissue of the crypts / anal glands
      • Can lead to fissure in ano, fistula in ano, perirectal abscesses

Clinical Features

• Anal pain
• Sphincter spasm
• Itching w/ or w/o bleeding
• Hypertrophied papillae

Differential Diagnosis

Anorectal Disorders

• Anal fissure
• Anal fistula
• Anal malignancy
• Anal tags
• Anorectal abscess
• Coccydynia
• Colorectal malignancy
• Condyloma acuminata
• Constipation
• Crohn's disease
• Cryptitis
• GC/Chlamydia
• Fecal impaction
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• Levator ani syndrome
• Pedunculated polyp
• Pilonidal cyst
• Proctalgia fugax
• Proctitis
• Pruritus ani
  • Enterobius (pinworms)
• Rectal foreign body
• Rectal prolapse
• Syphilitic fissure

Non-GI Look-a-Likes

• Prostatitis

Diagnosis

• Anoscopy shows inflammation, erythema, and pus

Treatment

1. Bulk laxatives, additional roughage, sitz baths (treats underlying cause)
2. Surgical referral is indicated when:
   1. Infection has progressed and the crypt will not drain adequately on its own
   2. Surgical treatment is excision

See Also

• Anorectal Disorders

Source

Tintinalli