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Abstract: The patient was a 52-year-old male who presented to the outpatient clinic with “mixed hemorrhoids for six months after surgery and now has difficulty in defecation”. On examination, he was found to have postoperative scar-like changes in the perianal area, and his index finger could not pass smoothly. After further examination, the diagnosis of anal canal stenosis was made, and after communication with the patient, surgery was recommended.
Basic information】Male, 52 years old
Type of disease】Anal stenosis
Hospital】Hegang City People’s Hospital
Date of consultation】March 11, 2021
Treatment plan】Surgical treatment (anal canal stenosis incision and dilatation)
Treatment Period】5 days hospitalization, 6 months follow-up
Treatment effect] Smooth stool, clinical cure
I. Initial consultation
The patient, Mr. Liu, 52 years old, visited the clinic because he had “mixed hemorrhoids for half a year after surgery and now has difficulty in defecation”. After inquiring about his condition, he learned that he had been treated for hemorrhoids at a hospital overseas six months ago. The patient reported that the wound healed later, but he felt discomfort from the tightness of the anus and had difficulty defecating whenever the stool was formed, and the stool streak was long and thin. The patient was then given a specialist examination of the anus: postoperative scar-like changes in the perianal area; the index finger could not pass smoothly during finger diagnosis, and there was a feeling of strangulation, and the patient had severe pain in the anus during finger diagnosis.
II. Treatment process
After the patient was admitted to the hospital, we communicated with him again and learned from the results of routine blood tests (as shown below) and the results of physical examination that he had failed to insist on medication changes and anal dilatation after hemorrhoid surgery, and that long-term oral laxatives had led to unformed stools and undilated anus. At the same time, too much skin and mucosal tissue may have been removed for the hemorrhoid surgery, and the combination of unfavorable factors eventually led to the formation of anal canal stenosis. I discussed the treatment plan with the patient, for early stenosis can be treated by manual anal dilation, late stenosis requires surgery, the patient has been for six months, suggesting the surgical approach. The patient agreed and completed the preoperative examination, and there were no contraindications to surgery. After clean enema, the patient was given intravenous anesthesia to perform anal canal stenosis incision and dilatation, and the operation was smooth without anesthesia accident and side injuries such as bleeding from the incision, etc. The patient returned to the ward and was given anti-inflammatory and anal dressing.
III. Treatment effect
After active and effective treatment, the patient passed shaped stool on his own on the second day after surgery; he was discharged from the hospital four days later and insisted on outpatient drug exchange treatment. 3 weeks later, the patient was cured and had normal stool, and the wound was completely healed, and the patient could carry out normal work and life; no recurrence of anal stenosis was seen in the follow-up period of six months. In summary, the patient was cured. Before the patient was discharged from the hospital, the patient was advised that he should be reviewed regularly to avoid any postoperative complications.
IV. Precautions
The patient was cured and discharged after active and effective treatment, and we are truly happy for him. Patients should eat more fresh vegetables and fruits, such as cabbage, bananas, kiwi, pears, etc., after surgery to enhance nutrition and pay attention to making stools take shape. Avoid spicy stimulating foods such as chili, raw onion, garlic, leek, pepper, etc. It is not advisable to eat hot things such as cinnamon, lychee and mutton. Relax emotionally after surgery and avoid excessive tension, so as not to cause frequent muscle spasms in the perianal area and cause re-contracture of the scar. Patients should come to the hospital for review on time after surgery.
V. Personal insight
In this case, the patient’s anal stenosis was caused by postoperative hemorrhoid surgery, and it was an acquired secondary anal stenosis, which lasted for half a year and developed into moderate or severe stenosis, significantly affecting the quality of life, and could not be cured without surgery. The patient was highly compliant during this treatment, cooperating with the doctor during hospitalization and insisting on outpatient review after discharge, with good final results. Therefore, the significance of the secondary anal canal stenosis warning is that patients with anal disease should insist on anal change, especially patients with circumferential mixed hemorrhoids should be treated with regular postoperative outpatient dilation to avoid anal canal stenosis; after anal disease surgery, oral laxatives are recommended in the early stage to avoid anal pain from dry stools, but it is not recommended to still take oral laxatives after 1 week, which can lead to anal canal stenosis due to wound adhesions caused by unformed stools. For patients with scarring, anorectal surgery should be carefully selected for treatment.