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Abstract: Anal fissures can be divided into early anal fissures and old anal fissures. In this article, Ms. Peng had anal pain symptoms for half a year, and the anal fissure examination could be judged as old anal fissures. For this kind of anal fissure, Ms. Peng also tried to treat it with medication, but the effect was not satisfactory, and finally consulted to choose surgical treatment, and the whole treatment process was still smooth without any accident, and she was discharged from the hospital with cure.
Basic Information】Female, 28 years old
Disease Type】Anal fissure
Hospital】Hegang City People’s Hospital
Date of Consultation】January 2022
Treatment plan】Surgical treatment (external hemorrhoidectomy, anal fissure excision) + medication (cefuroxime capsules, anti-inflammatory and muscle-building cream)
Treatment period】5 days of inpatient treatment, 3 weeks of postoperative outpatient medication change, regular review
Treatment effect】Anal pain during stool disappeared, good treatment effect
I. Initial consultation
Ms. Peng came to my office early in the morning and said that she was afraid to defecate, and when she went to the toilet to defecate, her anus hurt so much that it seemed like a knife was cutting it. After further questioning about her medical history, I learned that she had the habit of having dry stools and constipation, and that she had used medication for hemorrhoids on her own without seeing any improvement. She then examined her anus and found that there was an external hemorrhoid directly behind the anus and a pale fissure, about 1.0 cm long, was visible in front of the external hemorrhoid, and the pain in Ms. Peng’s anus was obvious during anal finger examination. At this time, I told Ms. Peng that she was diagnosed with old anal fissure based on the current symptoms and signs.
II. Treatment process
I communicated with Ms. Peng that the effect of medication for old anal fissure would not be ideal and that surgical treatment should be chosen. Ms. Peng nodded and was then hospitalized. After hospitalization, Ms. Peng did not have, cardiovascular and other medical disorders, and perfected the relevant examinations of blood routine, coagulation, and chest CT, suggesting high neutrophil percentage and possible slight infection, while other examination results did not show any abnormalities, excluding contraindication to surgery.
After adequate bowel preparation on day 2, external hemorrhoidectomy and anal fissure excision were performed under sacral anesthesia, and the procedure was very smooth and completed in about 10 minutes. On the 2nd postoperative day, he was instructed to start cleaning the anus, applying anti-inflammatory and muscle-generating cream topically to the anal incision, and changing the medication daily for symptomatic treatment.
(Blood count)
(Coagulation time)
III. Treatment effect
Ms. Peng did not have any accidents and complications during and after the surgery, and did not have any negative emotions, and the whole treatment experience felt relatively easy. On the second day after surgery, Ms. Peng defecated on her own, and the pain in her anus during defecation was relieved significantly. 5 days later, Ms. Peng’s anal incision healed, and no bleeding or infection was seen, so she was discharged. She continued the outpatient treatment for 3 weeks, and no recurrence of anal fissure was seen in 3 months of follow-up, which fully indicates that Ms. Peng got a good result of clinical cure.
IV. Notes
We are glad that Ms. Peng’s anal fissure was finally treated effectively, but we still need to advise Ms. Peng to pay attention to keep her anus clean, and her postoperative diet should prohibit spicy and stimulating food, and focus on easily digestible food, and increase the amount of vegetables and fruits to help keep the bowel movement smooth. When defecating, pay attention to not having dry stools and violent bowel movements, and to eliminate the bad habit of holding the stool, and to go to the toilet regularly when there is a stool, and it is better to develop the good habit of having a stool every morning.
V. Personal insight
Anal pain during defecation is usually the first consideration of anal fissure disease, this article Ms. Peng repeatedly many episodes, delayed into old anal fissure, this process usually takes more than 3 months, at this time need to choose surgical treatment. Ms. Peng has been suffering from the disease for half a year, with severe anal pain and difficulty in defecation, which has seriously affected her life. Although she was treated with medication but the effect was not good, the anal fissure was pale white, which was in line with the indication for surgery and there was no contraindication for surgery, so she accepted the doctor’s suggestion to choose surgery and finally obtained the clinical effect of healing. In addition, Ms. Peng listened to the doctor’s advice before surgery, followed the doctor’s instructions during treatment, insisted on outpatient medication change treatment after discharge, and insisted on outpatient follow-up, which received a good treatment effect, which shows the importance of cooperating with the doctor when treating diseases.