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Abstract: Perianal canker sores, also known as perianal abscesses, are the result of acute purulent infection of the soft tissues surrounding the anorectum. The patient in this case is a 26-year-old female who presented to the outpatient clinic with perianal swelling and pain for 5 days and fever for 1 day. After consultation and examination of the relevant specialists, the patient was diagnosed with anal canker. After discussing the solution with the patient, surgical treatment was performed, which consisted of abscess incision and drainage with internal sutures. After treatment, the symptoms subsided and the perianal swelling and pain disappeared.
Basic information】Female, 26 years old
Type of disease】Anal canker sores
Hospital】Hegang City People’s Hospital
Date of consultation】May 2021
Treatment plan】Surgical treatment (abscess incision and drainage + internal port hanging)
Treatment period】8 days of hospitalization, 5 days of outpatient follow-up
Effectiveness】Symptoms relieved, perianal swelling and pain disappeared, disease recovery
I. Initial consultation
The patient was a 26-year-old female who visited the outpatient clinic with perianal swelling and pain for 5 days and fever for 1 day. The patient entered the consultation room bent over with a very painful expression and could not sit on a stool. After asking about his condition, he was told that he had diarrhea after eating spicy hotpot 7 days ago, but he did not care about it. After the diarrhea was relieved, he developed anal swelling and pain 5 days ago without any treatment. The patient was then given an anal specialist examination: it was found that both sides of the anus were asymmetrical, the left anal margin was red and swollen and elevated, the size of a goose egg, the skin temperature was high and the tenderness was obvious. The patient was then informed that the diagnosis of canker sore was based on the present symptoms and specialist examination, and that the patient needed to be hospitalized for emergency surgical treatment.
II. Treatment
After the patient was admitted to the hospital, routine blood tests such as routine blood count, coagulation and four infectious diseases were completed, and the routine blood count showed a significant increase in white blood cells and a heavy infection. Preoperative history was carefully inquired and no contraindication to surgery was seen, and the patient was informed of the necessity and risks of surgery. The patient was concerned about postoperative anal function, so it was explained to the patient that if the internal opening of the abscess was obvious during intraoperative exploration, abscess incision and drainage and internal hanging would be performed to maximize the protection of anal function and no anal incontinence would occur; if the internal opening was not obvious, a phase I incision and drainage would be performed to drain the pus and resolve the infection, and when the internal opening was obvious, a phase II surgical treatment would be performed, which would also not damage anal function. The patient was then given intestinal cleansing and surgical treatment. During the operation, it was found that the infected internal opening was located directly behind the anus, and the patient was given perianal abscess incision and drainage, and the internal opening was threaded. The operation was smooth and took about 25 minutes, and the patient was returned to the ward after the operation.
III. Treatment effect
The patient underwent perianal abscess incision and drainage and internal port hanging, and the operation went smoothly without any anesthesia accident or intraoperative bleeding and other side injuries; the body temperature dropped significantly to 37.5℃ after the operation; the anal pain was relieved and tolerable; the blood routine was rechecked and the white blood cells dropped significantly, and the condition was initially controlled. During the follow-up, no recurrence of perianal abscess or fistula formation was observed, and no complications such as anal dysfunction appeared. All of the above indicate that the patient’s condition was clinically cured.
IV. Notes
We are glad that the patient’s condition was controlled and cured after active treatment. However, it is still important to note that there will be symptoms of low fever after canker sore surgery. Generally, it is not necessary to take antipyretic drugs, and the low fever can improve on its own by paying attention to keeping warm and drinking warm water in daily life. In addition, anal care should be strengthened after discharge from the hospital to keep the anal area hygienic and clean. It is recommended to use salt water to rinse the anus after stooling to keep the perianal area clean, which is conducive to wound recovery.
The diet should be light and nutritious, with high-protein and high-fiber foods recommended to enhance nutritional intake. Maintain good bowel habits to avoid dry stools or diarrhea caused by improper diet.
V. Personal insight
Anal canker sores can develop at any age, but are most common in young and middle-aged people between the ages of 20 and 50. Surgery is the preferred treatment for canker sores, and anti-inflammatory medication is generally not advisable. The scope of the abscess cavity can be clarified during surgery, and the most obvious place of skin redness and swelling can be selected for incision, and the abscess cavity should be drained smoothly. Also the active cooperation of the patient plays an important role in the treatment of the disease, as this patient underwent surgical treatment under the instruction of the doctor, and did the follow-up care work, timely cleaning of the anus, and eventually the treatment effect was good. We remind our friends to pay attention to the fact that the prevention of this disease focuses on eating less spicy food and keeping the bowels open, especially to avoid the occurrence of diarrhea. Life should be regular, the anus should be hygienically clean, and the discovery of uncomfortable symptoms should be sought, diagnosed and treated as early as possible.