Perianal abscess, also known as perianal abscess, is called anal abscess in Chinese medicine. Perianal abscess is an acute purulent infectious disease around anus, anal canal and rectum, which belongs to bacterial infection and is the predecessor of anal fistula. This disease and anal fistula are one of the three major anorectal diseases, with an incidence rate of about 2%, accounting for 8% ~ 25% of anorectal diseases. More common in men aged 20-40. The incidence rate of men is 3-4 times that of women, and the incidence rate of children is relatively high.
Attention should be paid to perianal abscess. Abscesses that occur in the ischial rectal fossa and pelvic rectal fossa on both sides of anus and under the fascia of male anterior perineum are the most dangerous. If not treated in time, it may lead to septic shock and even life-threatening.
Etiology this disease belongs to intestinal bacterial infection, and "intestinal bacteria" is its source and pathogenic factor. "Anal sinus" is the infection entrance and internal mouth after abscess and fistula. "Anal gland" is the route of infection, which spreads after infection. Perianal space is the final site of the lesion. Intestinal bacteria enter the anal sinus, causing inflammation, blocking the opening of anal gland, blocking the outflow of anal gland fluid, causing anal gland infection, which spreads to the perianal space through muscular space and lymphatic vessels, and finally forms abscess around anal canal and rectum.
The main clinical symptom of perianal abscess is pain. This kind of pain will be severe and will get worse gradually. Many patients say they can't eat or sleep. The pain will be relieved temporarily only after the abscess ruptures itself.
Severe anal pain will occur in low abscess, and this pain will continue unabated. Abscess around the rectum (high position) is not necessarily painful. Because the periphery of rectum belongs to pelvic cavity, the autonomic nerves distributed here are insensitive to common stimuli, mainly manifested as local swelling pain and defecation feeling.
Another symptom of perianal abscess is fever, which can exceed 40. Generally speaking, the larger and deeper the abscess cavity, the greater the probability of fever. Some patients will also have poor urination, loss of appetite, insomnia and so on.
There are not many options for the treatment of this disease. The only treatment is surgery, and the sooner the better. If there are no conditions or physical conditions that do not allow surgery, you can choose medication.
1. drug therapy
(1) Oral antibiotics can be selected for abscesses with anti-inflammatory surface, and broad-spectrum antibiotics are generally used. A large range of abscesses need to be combined with drugs, such as metronidazole, etimicin sulfate, kanamycin and streptomycin.
(2) External use of Huangjin Ointment, Huoxue Zhitong Powder, Sihuang Ointment and Yulu Ointment.
(3) Xue Ming's "Essentials of Surgery", an oral Chinese medicine, puts forward the treatment idea of dissipating first and supporting poison in the suppurative stage. You can add or subtract Xianfang Huosheng Decoction and Huanglian Jiedu Decoction.
2. Surgical therapy
(1) Suction, decompression and local disinfection. Puncture the abscess cavity from the weakest place with a 20ml syringe, draw out pus, and move the needle up and down while drawing until there is no pus to draw.
This method can temporarily reduce the tension of abscess cavity and relieve pain. It is suitable for temporary first aid, but it cannot replace surgery. If the disease develops rapidly, such as necrotizing fasciitis, it cannot be used to avoid delaying the disease.
(2) Incision and drainage were performed under local anesthesia, and the pus in the middle of the abscess cavity was drained through a small incision. After the operation, the abscess cavity was washed with metronidazole, and oil gauze was placed for drainage.
It belongs to temporary emergency, or the first operation of secondary operation. It can quickly expel pus and relieve symptoms, but it can't replace radical surgery. Generally, it takes about 3 months, and radical surgery is performed after the fistula is formed and the internal orifice is unobstructed.
(3) Radical operation ① Low abscess-direct incision. ② horseshoe abscess-incision and pus discharge. ③ Thread-drawing for high abscess. ④ High abscess-isobaric drainage. Because the thread cutting still cut off the anal straight ring, it hurts deeply. In order to further reduce the surgical trauma, bidirectional isobaric drainage can be used, and the abscess cavity can be healed without cutting off the anal straight ring and placing drainage tube during the operation.
Most perianal abscesses can be cured by active surgical treatment in the early stage of prognosis. The condition of high abscess is complicated and there is the possibility of recurrent attacks. Very few patients will die because of excessive infection.
There are many reasons to prevent perianal abscess, but the imbalance of intestinal flora and decreased immunity are the two fundamental reasons, so preventing intestinal flora imbalance and improving immunity are the fundamental measures to prevent perianal abscess.