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Abstract: Anal pain is a symptom common to many perianal diseases, such as anal abscess. In this case, a 56-year-old male patient presented to the hospital with “anal pain” as the first symptom and was diagnosed with anal abscess after treatment for hemorrhoids was ineffective. After the patient was diagnosed, he was given an emergency incision and drainage to control the infection due to severe comorbidities, and at the same time, he was treated actively for the comorbidities, and eventually the anal swelling and pain disappeared and he was discharged from the hospital.
Basic information】Male, 56 years old
Type of disease】Anal abscess
Hospital】Hegang City People’s Hospital
Consultation date】April 5, 2021
Treatment plan】Surgical treatment (abscess incision and drainage, anal fistula surgery) + drug treatment (recombinant human insulin injection, cefoperazone sodium sulbactam sodium for injection, sodium chloride glucose injection)
[Treatment cycle] 20 days of inpatient treatment, 2 weeks of postoperative outpatient medication change
【Treatment effect】Anal swelling and pain disappeared, incision basically healed, good treatment effect
I. Initial consultation
The patient, a 56-year-old male, was brought to our department lying on his side on a flat car. The patient was restless, breathing deeply and quickly, and could not communicate with him. After asking his family, we learned that the patient had developed anal swelling and pain 10 days ago, which was persistently aggravated, and thought it was an attack of hemorrhoids. The patient has a history of diabetes mellitus for many years, and usually uses insulin to lower glucose therapy, and has stopped using insulin on his own since the last month, and his diet is not controlled. Anal examination revealed a red and swollen bulge behind the anal canal, with a marked sense of fluctuation and severe tenderness. At this point, I initially considered the patient to have a perianal abscess combined with the manifestation of ketosis.
II. Treatment history
Due to the critical condition, the patient was hospitalized, and the fingertip blood glucose was 26.12 mmol/L. The patient was immediately given intravenous recombinant human insulin injection to lower glucose, and an endocrine consultation was also requested. The patient’s blood glucose was 26 mmol/L. The patient was immediately treated with recombinant human insulin injection to lower glucose and endocrine consultation was requested. The patient was then given an abscess incision and drainage under local anesthesia in the ward to relieve the infection. At the same time, the patient was given cefoperazone sodium sulbactam intravenous infusion for anti-infection, sodium chloride glucose injection for rehydration, and acidosis correction, etc. The patient was monitored for vital signs, blood glucose, renal function, ion, blood gas analysis and other indicators.
At the time of admission, the perianal abscess was not eradicated due to the need of the condition, and the abscess was taken for incision and drainage, after which an anal fistula was formed, requiring 2 surgical treatments to eradicate it. The patient expressed his approval and underwent elective anal fistula surgery, after which he recovered well and was discharged from the hospital. The patient’s blood sugar was well controlled at six months follow-up and no recurrence of disease was observed.
(Blood count)
III. Treatment effect
The patient’s condition improved in the afternoon of the day of incision and drainage, he was clear and could talk to people, anal pain was relieved significantly, and the indicators of routine blood and blood glucose decreased significantly on re-examination, and blood gas analysis indicated that acidosis was corrected. 3 days later, the patient’s blood glucose had been reduced to below 8.5mmol/L, and white blood cells returned to normal, and insulin hypoglycemic therapy was continued. 1 week later, antibiotics were stopped. After anal fistula surgery, the patient’s anal pain was reduced, his consciousness changed from coma to clarity, and the relevant laboratory indexes gradually returned to normal, and no incision infection or false healing occurred. Two weeks after discharge, the patient changed the medication at the outpatient clinic and said that the perianal pain symptoms disappeared, the incision basically healed and no other complications occurred, and the treatment effect was good, and the patient expressed that he was satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s anal abscess was effectively treated, but we also need to advise the patient to strictly implement the diabetic diet, not to relax the control of blood sugar, and to pay attention to exercise at ordinary times and exercise after meals, which is not only good for controlling blood sugar, but also can improve the immunity of the body and avoid the recurrence of the disease. Patients should do more anal lifting exercises to keep the perianal area clean and avoid secondary infection in the perianal area to induce anal abscess again. Patients should be advised to have regular outpatient review, especially when they have anal discomfort symptoms, so as not to delay the treatment.
V. Personal insight
The patient in this case was a middle-aged male with a history of diabetes for many years, who did not control his diet and interrupted his insulin hypoglycemic therapy without authorization, and his blood glucose increased significantly, and he developed anal abscess and diabetic ketoacidosis. The good thing is that the patient was seen in time, especially during the consultation and actively cooperated with the doctor, and eventually received satisfactory clinical results after comprehensive treatment. Since the patient had a history of diabetes, he should pay more attention to the control of diet, active control of blood sugar, timely control of anal infectious diseases and effective prevention of the recurrence of this disease after discharge from the hospital.