Perianal abscess, also known as abscess around the anus and rectum, is called anal carbuncle in traditional Chinese medicine. Perianal abscess is an acute suppurative infectious disease that occurs around the anus, anal canal and rectum. It is a bacterial infection and the precursor of anal fistula. This disease and anal fistula are one of the three major anorectal diseases, with an incidence rate of about 2% and accounting for 8% to 25% of anorectal diseases. It is more common in men aged 20 to 40 years old. The incidence rate in men is 3 to 4 times that in women. The incidence rate in children is also relatively high.
Treatment:
There are not many treatment options for this disease. The only cure is surgery, and the earlier the better. Medical treatment may be an option if surgery is unavailable or the physical condition does not allow it.
1. Drug treatment
(1) Anti-inflammatory superficial abscesses can be treated with oral antibiotics, generally broad-spectrum antibiotics. For relatively large-scale abscesses, combined medications such as metronidazole, etimicin sulfate, kanamycin, and streptomycin are required.
(2) For external use, apply Jinhuang ointment, Huoxue Zhitong powder, Sihuang ointment, Yulu ointment, etc.
(3) Oral administration of traditional Chinese medicine in the "Essentials of Surgery" edited and annotated by Xue Ji of Ming Dynasty proposes the treatment concept of dispersing it at the beginning and removing the toxin in the stage of pus formation. You can use Xianfang Huoshengyin and Coptidis Coptidis Jiedu Decoction.
2. Surgical treatment
(1) Pus extraction, decompression and local disinfection. Use a 20ml syringe to penetrate the abscess cavity from the weakest point of the abscess, extract the pus, and move it up and down while withdrawing. Use the needle until there is no more pus to draw out.
This method can temporarily reduce the tension in the abscess cavity and relieve pain. It is suitable for temporary emergency treatment, but it cannot replace surgery. If the condition develops quickly, such as necrotizing fasciitis, etc., it cannot be used to avoid delaying the condition.
(2) Incision and drainage: Under local anesthesia, make a small incision in the middle of the abscess cavity to drain the pus. After surgery, the abscess cavity is flushed with metronidazole, and oil gauze strips are placed for drainage.
It is a temporary emergency treatment or the first operation of secondary surgical treatment. It can drain pus and quickly relieve symptoms, but it cannot replace radical surgery. It usually takes about 3 months to complete radical surgery after the fistula is formed and the internal opening is clear.
(3) Radical resection ① Low abscess - direct incision. ②Horse hoof abscess - incision and exclusion. ③High abscess-seton surgery. ④High abscess-isobaric drainage. Because the anal ring is still cut off by cutting the seton, the pain is great and the wound is deep. In order to further reduce surgical trauma, bidirectional isobaric drainage surgical treatment can be performed. During the operation, half-cut setons are used and drainage tubes are placed, so that the abscess cavity can be healed without cutting off the rectal anal ring.