I. Definition
An abscess formed by an acute or chronic purulent infection in the perianal space is called perianal abscess. In Chinese medicine, it is called anal canker.
Diagnosis
1. Rapid onset, mostly seen in the subcutaneous space around the anus.
2. A perianal mass with redness, swelling, heat and pain, with fluctuating sensation or pus extracted by puncture.
3.Chill, fever, dry stool and difficulty in urination.
4. Increased total blood leukocyte count and neutrophils. Zhao Aimin, Department of Anorectology, Nantong Hospital of Traditional Chinese Medicine
Differential diagnosis
1, purulent sweat gland inflammation.
2, hair follicle inflammation.
3.Sebaceous cyst.
4.Thrombosed external hemorrhoid.
D. Examination
1.Compulsory examination items: finger diagnosis, visual examination, blood routine, etc.
2.Preparatory items: perianal ultrasound, coagulation index, blood sugar, liver and kidney function, electrocardiogram, pus culture, pathology, etc.
V. Treatment
(1) Traditional Chinese medicine (TCM): It belongs to the category of anal canker sores and is treated by internal and external therapies.
1. Internal treatment: If the evidence belongs to fire and toxicity, the treatment is to clear heat and fire, reduce swelling and softness. The evidence belongs to the heat and toxicity of the incandescent treatment to clear heat and detoxification, through the internal organs of heat, the formula is selected within the sparing Huanglian Tang plus or minus. If the evidence belongs to yin deficiency and toxin love, the treatment is to nourish yin and clear heat, the formula is selected from Artemisia turtle nail soup with reduction.
2, external treatment: external application: Fu Huang paste applied externally.
(B) Western medicine.
1, treatment principles: once septic, immediately incision and drainage, surgery should try to identify and remove the primary foci of infection, and retain postoperative wound drainage, so as to avoid posterior anal fistula, surgery should be as little as possible to damage the anal sphincter to protect the function of the anus.
2.Medication: anti-infection and systemic support therapy.
3.Surgical methods.
(1) Disposable incision and drainage and disposable incision and counter drainage are used for low perianal abscess with clear internal opening.
(2) Disposable incision and ligature and disposable incision and ligature counter-oral drainage for high-grade perianal abscess with clear internal orifice.
(3) Incisional drainage for perianal abscesses with unclear internal orifices or for those who are too weak to tolerate one-time surgery.
(4) Second-stage surgery.
(5) Incisional sphincter-sparing surgery and other sphincter-preserving procedures.