Perianal abscess is an acute purulent infection in the soft tissues around the anal canal and rectum or in the interstitial space around them, and the formation of abscesses, which are created by a variety of intestinal bacteria mixed infection. The clinical characteristics of this disease are: shallow abscess site, local redness, swelling, heat and pain, etc., is obvious, cold and fever and other systemic symptoms are not obvious, examination sees local redness and swelling, tenderness is obvious, the center has a fluctuating feeling. It is easy to confirm the diagnosis. If the abscess is higher and deeper, the local symptoms are often not obvious, and the symptoms such as swelling, soreness and discomfort are common, while the systemic symptoms such as feeling cold and fever are prominent, and the local visual examination is mostly abnormal. Finger palpation can find the area of pressure pain, or rectal nodes can find the area of mass or rich area, and puncture can draw out pus. Vascular augmentation is obvious. If multiple perianal interstitial infections are combined, the local and systemic symptoms are significant and the blood picture is abnormally elevated. The age of onset is predominantly 20-40 years. Sex: More males than females.
It is also known as canker sores in the anus in Chinese medicine. The disease is also known in Chinese medicine as: dirty poisonous anal canker, pan anal canker, hanging canker, cross-horse canker, gunk canker, etc. The disease is rapid and painful, and if misdiagnosed or improperly treated, it can often lead to extensive tissue destruction around the anus and even sepsis and death. Therefore, once the above situation occurs, you should go to the hospital immediately and be hospitalized immediately after a clear diagnosis.
The causes of perianal abscess are mostly due to poor diet, excessive consumption of spicy and fatty flavors, internal growth of dampness and heat, and heat poisoning of the anus. Or due to damage to the anal skin, infection with poisonous evil, stagnation of blood stasis, obstruction of meridians, and corruption of blood and flesh. According to the investigation of the causes of perianal abscess in our hospital in the past two years, 70% of the patients had obvious triggers for the attack, including: 54.4% for eating spicy and dry food; 20.6% for drinking alcohol; 8.8% for overworking; 4.4% for sitting for a long time; 4.4% for sitting and lying on wet ground; 2.9% for eating greasy food; 2.9% for being cold; and 1.5% for developing with menstruation. If the abscess is not treated in time, it often has three outcomes as follows.
1. further diffusion along the sphincter space
2. drainage of pus by perianal skin penetration → anal fistula.
3.Pus penetration through the anal sinus or intestine → internal fistula.
4.The possibility of self-healing is very small.
The classification of perianal abscesses is high above the anal tilt muscle and low below the tilt muscle.
1.Low perianal abscess: located in the gap below the levator. Local redness, swelling and heat pain are the main symptoms, and systemic symptoms are not obvious. There are also
(1) Pre (post) anal canal superficial interstitial abscess.
(2) deep interstitial abscess of the anterior (posterior) anal canal.
(3) scirorectal hiatus .
(4) perianal hiatus.
(5) low sphincter gap and other five types.
2, high perianal abscess: located above the mention, to the cold line. , high fever, malaise, glandular mass and other systemic symptoms are predominant, and the blood picture is high. Local symptoms are relatively mild. There are often
(1) abscesses in the pelvic rectal space.
(2) posterior rectal hiatus .
(3) rectal bladder (uterine) hiatus.
(4) high sphincter interstitial and four other types.
3. Joint interstitial abscess also called complex abscess: abscess involving more than 2 interstitial spaces. Both systemic and local reactions are heavy. There are often
(1) low joint interstitial abscess;
(2) High joint interstitial abscesses ;
(3) high and low combined interstitial abscesses and
(4) four types of submucosal abscesses of the rectum. Treatment of perianal abscess: “Pus becomes a decision by knife and needle” and incision and drainage of pus is the first priority. After that, the treatment is combined with heat sliding, detoxification and dampness removal, antibacterial and symptomatic treatment.
There are two methods of surgery respectively
(1) Staged surgery (popular in the 1970s and still the main method in many small-scale medical institutions), for superficial and simple abscesses, incision and drainage in the center of the abscess can be done without anesthesia or under local anesthesia. In cases of deep abscesses or multiple interstitial co-infections, lidocaine is used as regional anesthesia, and after the anus is released, incision and drainage is performed. The direction of the incision should be different depending on the size and location of the abscess, and the method of radial incision should be used. After draining the pus, the pus cavity is flushed with hydrogen peroxide, saline, 0.5% methotrexate or gentamicin in turn. Check that no bleeding is issued and the wound is left in rubber drainage. After the acute inflammation has subsided and the pus cavity has contracted and changed to form a fistula (usually about 3 months), a second-stage surgery is performed – radical fistula surgery.
(2) Abscess primary radical pedicle (99% of patients in our hospital are mostly treated by this method) After successful anesthesia, the site, scope, and internal opening of the abscess are determined by finger examination, probing, and Melan staining. For low abscesses, a radial incision is made along with the internal opening, the pus cavity is scratched, the wound is flushed, and the wound is sutured or not sutured depending on the situation. The wound is compressed and drained with vancomycin gauze. If the abscess involves more than the anorectal ring, the abscess cavity below the anorectal ring of the hemorrhoid is completely cut open, the anorectal ring is exposed, a rubber band is put through the abscess cavity and out of the inner opening, and the rubber band is stretched and tied. If the abscess is horseshoe-shaped, an arc-shaped incision is made on both sides of the anus, a row of incisions is made on the posterior side of the anal canal, and the inner port is drained with a hanging thread, then the abscess cavity is scratched and flushed, the distal end is sutured, and the proximal end is drained with Vaseline or rubber.
The points that need to be noted for the root treatment of anal pus are.
(1) Accurate positioning. The site, scope, and internal opening are clearly defined before surgery. The site can be determined by finger diagnosis and puncture under anesthesia. Determine the internal orifice by anal clock, finger diagnosis, probing, staining, etc. If the internal opening is unknown, staging is appropriate.
(2) The incision should not be too large, and adequate drainage is sufficient. The abscess cavity should be fully opened and no dead cavity should be left. Finger probing and separation of the fibrous septum of the abscess swollen endogastric can be used during the operation to facilitate drainage.
(3) The surgery should pay attention to the protection of anal function. One-time incision of the sphincter or the rectal ring is not advocated, especially when the sphincter or the rectal ring involved in a high abscess is more, and incision will definitely lead to anal incontinence. Therefore, the hanging wire method is advocated. The distal end should be sutured if the wound is deep and large, which can accelerate the wound healing and reduce the healing process, and reduce the scar area and the anal deformity. Practice has proved that as long as the operation is accurate, the abscess cavity and primary foci are cleaned, and the proximal wound is drained smoothly, there will be no infection.
To prevent perianal abscess, the main thing is to try not to drink alcohol, eat a light diet, and avoid prolonged sitting, squatting and overexertion.