Little C is a tragedy, he was confused to die of an “insignificant” disease.
He had a pain in his buttocks for a few days, so he went to see a friend who is a doctor in this field. I hadn’t heard of such a disease before, so I didn’t pay attention to it, and I went home after my buddy’s doctor had drawn pus and injected a drip. The pain suddenly increased after three days and was accompanied by fever, because I was busy doing business, and resisted for two days, to the fifth day really can not stand and went to see a buddy doctor. After surgical treatment, the condition did not improve, the infection spread rapidly on the seventh day, and was urgently transferred to a provincial hospital, where he died 10 days later, despite all efforts to save him. The cause of death, “necrotizing fasciitis”. [Figure 1
You wouldn’t think that perianal inflammation could kill someone? Don’t worry, let me continue.
In a remote prefecture-level city in a southwestern province, an anorectal hospital was besieged by dozens of people one day in 2013. The cause was a 40-year-old male patient who was admitted to this hospital five days ago with a fever and died yesterday. A strong labor force should die because of fever buttocks pain, the family could not accept the fact, so they had to vent their anger to the hospital via the treatment. Cause of death, “perianal abscess”. [Figure 2, Figure 6
Sobering! Again, it was a perianal inflammation.
In our common knowledge, when we talk about perianal disease, we are afraid that hemorrhoids come to mind, what is this perianal inflammatory disease? How can it be so deadly?
Acute inflammation is a battle between the body’s immune cells and harmful germs, and is characterized by redness, swelling, heat and pain. Chronic inflammation is a problem with the body’s immune system, where the immune cells cannot identify the “enemy” and fight with the body’s normal cells, causing localized congestion and edema or ulceration, which manifests as hidden pain, swelling or itching.
There are also acute and chronic perianal inflammatory diseases. In addition to the above-mentioned necrotizing fasciitis and perianal abscess, there are also anal fistulas [Figure 4], purulent sweat glands [Figure 3], hair cysts, epidermoid cysts, and sacrococcygeal teratomas. Although these diseases are not as prevalent as hemorrhoids, they are far more painful and harmful than hemorrhoids.
For example, perianal abscesses, which first form localized destruction in the perianal area (fatty tissue, muscle tissue, nerves and blood vessels), may spread beyond the perianal area or endanger life through bloodstream infection if they are not treated reasonably effectively. Even if life is not at stake, the fistula will eventually form and the infection will not heal repeatedly.
Unlike other parts of the body, acute inflammatory diseases of the perianal area can only be cured by surgery, the effectiveness of which depends on the severity of the disease and the experience of the surgeon. It should be noted that surgery for these diseases is highly specialized and cannot be perfunctorily entrusted to a random surgeon; recurrence not only increases and perpetuates the pain, but also makes reoperation more difficult [Figure 5].
The main chronic inflammatory diseases of the perianal area are sinusitis, anal papillitis, anal canalitis, perianal dermatitis, and leukodystrophy. Among them, sinusitis is the most headache.
Speaking of sinusitis [Figure 7], the author once described this disease in the article “Talking about anal neuropathy”: “There is a strange disease in the anorectal department, the patient is very painful, but can not see, feel, can not be investigated. Sometimes, the anus is swollen, painful and painful, and sometimes there is a feeling of frequent bowel movements, unclean bowel movements, insect crawling and burning sensation, and sometimes it also involves the perineum, waist, crotch, sacrum and even the lower limbs. The symptoms are persistent or recurrent. It is also accompanied by poor sleep, insomnia and mental depression over time. Some patients describe it as worse than death, and individual patients appear to live lightly. This disease is not rare, basically all ages can develop, from 20 to 80 years old, but with a high incidence of 40 to 50 years old, more women than men.”
There was a 55-year-old female patient who, upon entering the clinic, knelt down on the floor and cried for me to save her. She had been suffering from anal sinusitis for 5 years and had seen famous doctors in more than 10 places across the country and had undergone 3 surgeries, but there was no relief at all. Now is not good to eat, sleep, anal pain at all times, most of the time in is lying in bed. Several times I wanted to lightly live, but was stopped by my family.
Sinusitis may seem unfamiliar to many people, but in fact this disease is very common in hospital outpatient anorectal clinics. Due to the hypersensitivity of the anal sinus, any stimulus will produce a significant response. The chronic inflammatory stimulation is persistent and the local painful sensation is bound to cause a mental chain reaction in the long run, and it is not difficult to explain depression, lightness of life, loss of work capacity and desire to live. A patient with sinusitis is not only a personal pain, but often a family pain as well.
Again, perianal dermatitis is a very common disease in which perianal dampness and itching are common symptoms. This itching often comes on at night and can keep people awake at night. There are pain relief shots in medicine but no itch relief shots, so the severe itching can sometimes be positively maddening.
Chronic inflammatory perianal disease is difficult to treat, but it is not completely untreatable. A scary clinical phenomenon is that many of these patients are treated with surgery. It is understandable that patients are in pain and want a good way to get rid of the disease right away, even if they ask for surgery. But as a doctor, this is the time to consider the pros and cons. The failure of a surgery is not only a local damage, but also a blow to the patient’s spirit. In fact, clinically, through a combination of Chinese and Western medicine, many patients’ conditions have been effectively controlled.
The anus is an embarrassing part of the body with problems that many people find unspeakable. The alarm signals of perianal inflammatory diseases are: pain, swelling and itching. If such signals appear, you wish to seek professional medical consultation. Health is not there, which is still no face, even if it is an embarrassing part, the problem appears to have to speak.
Fig. 1 Necrotizing fasciitis with a range of invasion of the perianal area, perineum and scrotum.
Figure 2 Perianal abscess in different areas
Figure 3 Perianal purulent sweat glands
Figure IV Anal fistula, horseshoe shape.
Figure V Anal fistula with recurrence and anal deformity due to improper surgery.
Figure 6 Schematic diagram of perianal abscess, with the abscess site in green area.
Figure VII Schematic diagram of the site of onset of anal sinusitis