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Abstract: A 42-year-old male patient who had a swelling prolapsing from the anus after defecation for 1 year with intermittent blood in the stool came to our hospital and was diagnosed with mixed hemorrhoids after examination. After 1 week of treatment with mixed hemorrhoids with external peeling and internal ligation, as well as injectable cefuroxime sodium, potassium permanganate solution, and ibuprofen extended-release capsules, his symptoms improved and he fully recovered after 1 month of review.
Basic information】Male, 42 years old
Disease Type】Mixed Hemorrhoids
Hospital】The First Affiliated Hospital of Xi’an Jiaotong University
Date of Consultation】May 2022
Treatment plan】Surgical treatment (external and internal ligation of mixed hemorrhoids) + intravenous injection (cefuroxime sodium for injection) + topical medication (potassium permanganate solution) + oral medication (ibuprofen extended-release capsules)
Treatment period】Inpatient treatment for 1 week, review after 1 month
Treatment effect] Symptoms improved and the condition was stable
I. Initial consultation
One year ago, the patient found a swelling prolapsing from the anus after defecation without any obvious cause, and was able to return it by himself, with intermittent blood in the stool, small amount, bright red color, no urgency, no diarrhea, no chills and fever, no chest tightness and breathlessness, and no obvious change in urine. The patient was treated outside the hospital, and now she came to our hospital. Outpatient visual examination: the anus was centered, no deformity was seen, no redness or swelling, and the skin of the anal margin was hypertrophied and elevated at points 3, 7, and 11 and connected to the prolapsed mass in the anus. Finger palpation: no narrowing of the anal sphincter, mucosal elevation at the dentate line at points 3, 7 and 11, and no finger staining. Anoscopy: mucosal elevation at the dentate line at 3, 7 and 11 o’clock, bright red color, red rectal mucosa without abnormal masses. The preliminary diagnosis was: mixed hemorrhoids, and the patient was admitted to our hospital.
II. Treatment history
After the patient was admitted to the hospital, combined with his medical history and relevant examination results, we considered that external peeling and internal ligation of mixed hemorrhoids would be more effective, and carried out treatment after obtaining the patient’s consent. The patient was given local anesthesia, an incision was made at the edge of the external hemorrhoid, the varicose vein mass and the hyperplastic connective tissue were peeled off, and methylene blue injection was used under the ligature line of the internal hemorrhoid and at the edge of the incision to provide long-lasting pain relief, and the patient was sent back to the ward after the operation. Postoperatively, cefuroxime sodium for injection and potassium permanganate solution were given in sitz bath for anti-infection treatment. On the second postoperative day, the effect of anesthesia wore off and the patient had obvious wound pain, he was instructed to take ibuprofen extended-release capsules.
III. Treatment effect
Before treatment, the patient had a swelling prolapsed from the anus after stool, accompanied by intermittent blood in the stool. The patient was discharged after 1 week of sitz bath with injectable cefuroxime sodium and potassium permanganate solution after admission for external peel and internal ligation of mixed hemorrhoids. 1 month later, the patient returned to the hospital for review, and should be seen promptly if wound redness, pain, bleeding and edema occur during this period. The patient returned to the hospital for review. Visual examination did not show any mass prolapse, finger examination did not show anal sphincter stenosis, and there was no mucosal elevation. Anoscopic examination: no abnormal masses were seen in the red mucosa.
IV. Precautions
After 1 week of hospitalization, the patient’s recovery is progressing well, but not fully recovered, and the following points should be noted after discharge.
1. the patient still needs to strengthen the care of the surgical site after discharge, keep it clean and dry, and avoid contamination by sweat, blood and feces.
2. early postoperative period it is recommended to rest more in bed to avoid walking leading to friction of the surgical incision and complications such as bleeding and edema.
3, the diet should be light and easy to digest, avoid the intake of raw, cold, spicy and stimulating food, so as not to aggravate the symptoms of discomfort.
4.After the recovery of the disease, appropriate functional exercise, such as anal lifting exercise, can increase the anal contraction force.
V. Personal insight
The main manifestation of mixed hemorrhoids is the prolapse of anal swelling, which can be accompanied by blood in the stool, pain and anal swelling, etc. Early treatment can be cured by adjusting diet, improving bad habits and medication. If the treatment is not timely, it will not only cause anal eczema, perianal abscess, necrosis, etc. to increase the pain of patients, but also the treatment cost will be increased in different degrees. As in this case, the patient came to the clinic 1 year after the symptoms appeared. Although the patient recovered well after surgery, early treatment can largely reduce the patient’s pain as well as reduce the treatment cost.