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Objective:To observe the clinical effect of Sanhuang Qingre Fuming and Washing Decoction combined with Chinese medical excision in the treatment of horseshoe-shaped perianal abscess after high position and to explore its mechanism of action.Methods:Randomized controlled trial. Sixty surgical patients in our hospital from April 2020 to February 2021 were selected as observation objects. The patients were divided into two groups according to the random number table, with 30 patients in each group. Both groups were treated with Traditional Chinese Medicine drainage. On the second day after operation, the control group was treated with potassium permanganate sitz bath fumigation and washing, and the observation group was treated with Sanhuang Qingre Fuming and Washing Decoction. The wound healing time was observed in the two groups, serum TNF-α, IL-1β, IL-6, VEGF, bFGF, and EGF levels were detected by ELISA on the 1st and 7th d after operation, respectively. Serum SOD level was detected by the chemiluminescence method, and serum MDA level was detected by thiobarbituric acid method.Results:The wound healing time in the observation group was shorter than that in the control group ( t=3.37, P<0.01). The recovery rate was 93.3% (28/30) in the observation group and 76.7% (23/30) in the control group. The difference was statistically significant between the two groups ( χ2=4.32, P=0.038). Seven days after surgery, the levels of serum TNF-α, IL-1β and IL-6 in the observation group were significantly lower than those in the control group ( t values were 2.01, 2.05 and 4.88, respectively, P<0.05 or P<0.01), the level of SOD was significantly higher than that of the control group ( t=-2.13, P=0.038), the level of MDA water was significantly lower than that of the control group ( t=3.26, P=0.002), and the levels of VEGF, bFGF and EGF were significantly higher than those in the control group ( t values were -2.02, -3.33, -3.77, respectively, P<0.05). Conclusion:Sanhuang Qingre Tuming and Washing Decoction combined with Chinese medical excision in the treatment could shorten the healing time of the wound surface of horseshoe-shaped perianal abscess after high elevation and improve the recovery rate. The Sanhuang Qingre Fuming and Washing Decoction may reduce inflammatory reaction and oxidative stress damage, improve the level of growth factors and facilitate the postoperative tissue repair.
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Background: This study was conducted to compare the use of different setons with conventional management like fistulotomy and fistulectomy in terms of healing (after 1 and 3 months), recurrence and incontinence.Methods: This was a retrospective non-randomized study conducted at JNMCH, Aligarh from January 2018 to June 2019. Patients included- patients (males and females) of age group 18-70 years, patients giving consent. Patients excluded- fistula secondary to- Crohn’s disease, tuberculosis, malignancy, recurrent fistula, pregnant females, immuno-suppressed patients.Results: After 1 month, 17 out of 24 patients (70.8%) of fistulotomy, 48 out of 68 patients (70.6%) of seton group and 21 out of 32 patients (65.6%) of fistulectomy group had their wounds healed (p=0.8693). After 3 months, 19 out of 24 (79.2%) patients of fistulotomy, 61 out of 68 (89.7%) of seton, and 24 out of 32 patients (75%) with fistulectomy had their wound healed (p=0.1374). Recurrence was observed in 5 out of 24 patients of fistulotomy, 10 out of 68 patients of seton use and 5 out of 32 patients with fistulectomy (p=0.7788). 6 out of 24 patients (25%) had incontinence after fistulotomy, 7 out of 68 (10.3%) of seton group and 8 out of 24 (25%) after fistulectomy (p=0.0944). Healing was higher in patients of non-cutting setons as compared to cutting seton (p=0.0252). After 3 months, no difference was observed (p=0.1245). Recurrence higher in cutting setons as compared to non-cutting setons (p=0.0187).Conclusions: Setons are safe, low-cost, less invasive, precise, and cost-effective option for treating simple and complex fistula-in-ano.
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Objective:To investigate the effect of ultrasonic debridement machine for postoperative cleaning of perianal abscess.Methods:77 patients with perianal abscess were enrolled in this study.They were divided into control group (38 cases) and observation group (39 cases) by random sampling.The control group was implemented routine treatment post operation and the observation group was implemented routine dressing combined with ultrasonic cleaning machine to clean the crissum.And the visual analogue scale (VAS) was adopted to analyze the pain level of postoperative wound.And the postoperative clearance rate of bacteria, wound healing time, controlled time of infection and cleaning effect of wound between two groups were compared.Results:The VAS score of the observation group on the 1st, 3rd, 5th and 9th day after operation were significantly lower than those of control group (t=8.031, ■on wound of observation group was significantly higher than that of control group while the length stay in hospital of■healing time and controlled time of infection of observation group were significantly lower than those of control group■machine to clean wounds after perianal abscess surgery can effectively remove bacteria of wound, and improve cleaning effect, alleviate pain level of wound, and promote the rapid repair of wounds.
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Objective@#To explore the efficacy of closed negative pressure irrigation and suction device (Patent number: Z200780013509.8) in the treatment of high perianal abscess.@*Methods@#From January 2015 to December 2016, ≥18-year-old patients with primary high perianal abscess who were treated at our department were prospectively enrolled. Exclusion criteria: (1) recurrent perianal abscess; (2) complicated with anal fistula formation; (3) preoperative, intraoperative or postoperative physical therapy, and curettage treatment, negative pressure irrigation; (4) Crohn′s disease-related perianal abscess; (5) with immunosuppressive status, such as transplant recipients; (6) co-existence of malignant tumors, such as leukemia; (7) with diabetes; (8) those who could not receive long-term follow-up and were not suitable to participate in this study. According to the random number table method, the patients were randomly divided into negative pressure irrigation and suction group and routine drainage group. All patients were clearly diagnosed and the location and size of the perianal abscess were marked before surgery. These two groups were treated as follows: (1) Negative pressure irrigation and suction group: the skin was incised at a diameter of 1-2 cm at the site where the abscess fluctuated most obviously. After the abscess was removed, a closed negative pressure irrigation and suction device was installed and the pressure of -200 to -100 mmHg (1 mmHg=0.133 kPa) was maintained to keep the abscess cavity collapsed. Generally, the irrigation was stopped 5 days later or when the drainage was clear. The closed vacuum suction was maintained for 2 additional days, before the wound was sutured. (2) Conventional drainage group: conventional incision and drainage was carried out. The skin was cut at a diameter of 8 to 10 cm at the site of abscess with most obvious fluctuation. After the abscess was removed, normal saline gauze was used for dressing. Dressing was changed regularly until the wound healed. The efficacy, operative time, intraoperative bleeding, incision length, frequency of dressing change, pain index (visual analogue score, VAS score), postoperative healing time, complications, recurrence rate of perianal abscess, anal fistula formation rate were observed. The t test and χ2 test were used for comparison between the 2 groups.@*Results@#There were both 40 patients in the negative pressure irrigation and suction group and the conventional drainage group. There were 28 males and 12 females in negative pressure irrigation and suction group with a mean age of (38.3±12.0) years and mean disease course of (6.6±2.1) days. The abscess in pelvic-rectal space accounted for 50.0% (20/40) and the mean diameter of abscess was (8.0±3.7) cm. There were 26 males and 14 females in the conventional drainage group with a mean age of (37.1±11.8) years and mean disease course of (6.4±2.5) days. The abscess in pelvic-rectal space accounted for 55.0% (22/40) and the diameter of abscess was (8.2±3.5) cm. The differences in baseline data between two groups were not statistically significant (all P>0.05). Both groups successfully completed the operation. There was no significant difference in operative time between two groups (P>0.05). As compared to conventional drainage group, intraoperative blood loss in negative pressure irrigation and suction group was less [(12.1±5.5) ml vs. (18.3±4.4) ml, t=5.606, P<0.001], incision length was shorter [(2.3±0.8) cm vs. (7.6±1.7) cm, t=17.741, P<0.001], postoperative VAS pain scores at 1-, 3-, 7-, and 14-day after operation were lower [3.7±1.4 vs. 7.6±1.8, t=10.816, P<0.001; 3.0±1.3 vs. 6.8±1.6, t=11.657, P<0.001; 2.7±0.9 vs. 5.1±1.1, t=10.679, P<0.001; 1.2±0.3 vs. 1.6±0.4, t=5.060, P=0.019], the dressing change within 7 days after operation was less (3.5±1.2 vs. 12.6±2.7, t=19.478, P<0.001), postoperative healing time was shorter [(10.4±3.0) d vs. (13.5±3.8) d, t=4.049, P<0.001] and postoperative complication rate was lower [17.5% (7/40) vs. 2.5% (1/40), χ2=5.000, P=0.025]. During follow-up of 12 to 36 (24±5) months, the recurrence rate of perianal abscess within 1 year after operation and anal fistula formation rate in negative pressure irrigation and suction group were lower than those in conventional drainage group [5.0% (2/40) vs. 20.0% (8/40), χ2=4.114, P=0.042 and 2.5% (1/40) vs. 17.5% (7/40), χ2=5.000, P=0.025, respectirely]. The one-time cure rate of negative pressure irrigation and suction group and conventional drainage group was 92.5% (37/40) and 62.5%(25/40), respectirely (χ2=10.323, P=0.001).@*Conclusions@#The application of the negative pressure irrigation and suction device in the treatment of high perianal abscess can improve the efficiency of one-time cure, reduce postoperative pain, accelerate healing time, decrease the morbidity of postoperative complication and the rates of abscess recurrence and anal fistula formation, indicating an improvement of the treatment.
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OBJECTIVE:To investigate therapeutic efficacy and safety of the use of Kubai oil and Cuyu oil by stages on wound healing after perianal abscess operation.METHODS:A total of 125 observation objects selected from Chengdu Third People' s Hospital during Jan.2014-Jan.2016 were randomly divided into control group (60 cases) and observation group (65 cases).Both groups received perianal abscess incision drainage or thread-drawing drainage.Control group was additionally given gentamicin gauze for dressing and other treatments after surgery based on routine treatment.Observation group was given Kubai oil gauze for dreassing in wound inflammation period,Cuyu oil gauze for dressing in granulation growth period and epithelial growth period.After 4 weeks of treatment,therapeutic efficacy,wound healing,wound pain,wound secretion and the growth of granulation tissue were compared between 2 groups.The occurrence of ADR was also recorded.RESULTS:The cure rate of observation group reached 80.0％,which was significantly higher than 63.3％ of control group (P＜0.05);the reduction rate of wound area was significantly higher than control group,while the carrion shedding time and wound healing time were significantly lower than control group (P＜0.01 or P＜0.05).The wound pain score in 2nd,4th week,the wound secretion score and granulation tissue growth score in 1st,2nd,4th week after operation were significantly lower than control group (P＜0.01 or P＜0.05).No significant ADR was found in 2 groups.CONCLUSIONS:For the patients underwent perianal abscess operation,the use of Kubai oil and Cuyu oil by stages can effectively improve therapeutic efficacy and wound healing,and relieve postoperative pain with good safety.
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Objective To explore the clinical effect of transrectal ultrasound-guided puncture and cathetering drainage in the treatment of high-position perianal abscess. Methods Eighty patients with high-position perianal abscess, who admitted to Shuguang Hospital of Shanghai University of Traditional Chinese Medicine from Jan. of 2015 to 2018, were randomized into interventional therapy group and surgical treatment group, with 40 cases in each group. The patients in the interventional therapy group were treated with cathetering drainage guided by transrectal ultrasound, and the patients in the surgical treatment group were treated with traditional incision drainage. The clinical effect was evaluated in the two groups, and the pain, fever and exudation scores, white blood cell count, C-reactive protein level, maximal section area of abscess cavity, and wound healing time were compared between the two groups before operation and on 3 days and 7 days after operation. Results The total effective rates of the interventional therapy and surgical treatment groups were 87.5% (35/40) and 80% (32/40), respectively, and the difference was significant (χ2=1.385, P=0.709). On 3 days and 7 days after operation, the pain score, exudation score, white blood cell count, C-reactive protein level and maximum section area of the abscess cavity were significantly lower in the interventional therapy group than those in the the surgical treatment group (all P<0.01). The patients with retrorectal abscess or high intersphincteric abscess in the interventional therapy group had shorter wound healing time versus the patients in the surgical treatment group (both P<0.01). Conclusion Compared with traditional incision drainage, cathetering drainage guided by transrectal ultrasound can reduce pain and decrease exudation of the patients with high-position perianal abscess to effectively control infection.
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Crohn's disease is an inflammatory bowel disease that affects the intestinal bowel in a transmural way presenting with fistulizing phenotypes with abnormal communication between two epithelial surfaces. In perianal Crohn's disease, there are fistulizing tracts between the anal canal and perianal skin that can complicate with abscess formation. Symptoms include pain, perianal discharge and fluctuating lesions, requiring combined clinical and surgical management. The disease is difficult to treat and is associated with significant reduction in quality of life, requiring a multidisciplinary approach for the management of these patients. The following review describes clinical concepts of perianal Crohn's disease, with emphasis on diagnosis and treatment.
La enfermedad de Crohn es una enfermedad inflamatoria del tubo digestivo con compromiso transmural de la pared que puede manifestarse con fenotipos fistulizantes mediante el desarrollo de comunicaciones anormales entre dos superficies epiteliales. En el caso de la enfermedad de Crohn perianal se establecen trayectos fistulosos entre el epitelio del canal anal y la piel alrededor del ano, que pueden complicarse con la formación de abscesos. Clínicamente se presenta con descarga perianal, dolor y masa fluctuante requiriendo un manejo conjunto médico-quirúrgico para el tratamiento de las complicaciones, el control de las fístulas y el compromiso luminal asociado. Es necesario un enfoque multidisciplinario dado que es una enfermedad de difícil manejo que afecta la calidad de vida de los pacientes. En la siguiente revisión se exponen conceptos acerca de la enfermedad de Crohn fistulizante perianal y sus complicaciones, con énfasis en el diagnóstico y tratamiento.
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Humans , Crohn Disease/complications , Rectal Fistula/diagnosis , Rectal Fistula/etiology , Rectal Fistula/therapy , Magnetic Resonance Imaging , Inflammatory Bowel Diseases/complications , Rectal Fistula/classification , AbscessABSTRACT
Objective To investigate the clinical effect of low/low pressure drainage radical resection in the treatment of high perianal abscess.Methods Eighty-six patients with high perianal abscess treated in Tangshan Traditional Chinese Medicine Hospital from Octorber 2014 to Octorber 2016 were selected and randomly divided into the observation group(44 cases)and the control group(42 cases).The observation group was treated with decompression and drainage radical surgery,while the control group was treated with one-stage incision and thread drawing radical surgery.The postoperative conditions of the two groups were observed, including pain,anal function,healing time and clinical effect,and statistical analysis was made on the quantitative scores of the above indexes.Results The cure rate of the observation group was 100%(44/44), significantly higher than that in the control group(90.47%(38/42)),and the difference between the two groups was statistically significant(χ2=4.395,P=0.036).The postoperative pain score of the observation group was(1.681±0.945)points,significantly lower than that in the control group((3.328±1.300)points),and the difference was statistically significant(t=-4.504,P=0.000); The number of recurrence(0 cases)was significantly lower than that in the control group(4 cases)(P=0.036).The healing time of the observation groups was(22.08± 2.12)d, significantly lower than that in the control group((37.552± 2.61)d),and the difference between the two groups was statistically significant(t=29.0411,P=0.000);The anal function score of the observation group was(1.681±0.838)points,significantly lower than that in the control group((2.809 ±0.928)points),and the difference between the two groups was statistically significant(t = -3.217,P=0.000).Conclusion Low pressure drainage radical is an effective surgical method for sphincter preserving radical treatment of high perianal abscess,which not only preserves the sphincter and anus straight ring,but also reduces the postoperative anal function and the degree of morphological damage and the surgery the pain and length of hospital stay and cost saving.
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Objective To explore the difference of the curative effect between incision-thread-drawing procedure and traditional incision drainage in the treatment of perianal abscess.Methods A total of 150 patients diagnosed with perianal abscess and treated at the first time from June 2015 to June 2016 in our department were selected as the research object in this experiment,who were divided into the observation group(75 cases) and control group(75 cases) according to the surgical method.Patients in the observation group were performed with incision-thread-drawing procedure,while the control group were treated by traditional incision drainage.The overall treatment effect,operation time,postoperative recovery time,hospital stay,hospital costs,wound healing time and postoperative complications between the two groups were observed and compared.Results The difference of the overall treatment effects between two groups were not statistically significant(P>0.05).The operation time,the postoperative recovery time,the hospitalization time and the cost,the time of wound healing of observation group were significantly better than the ones of the control group,the differences were statistically significant(P<0.05).The recurrence rates of anal fistula,abscess and other complications in patients of observation group were significantly lower than the ones of control group.The differences were statistically significant(P<0.05).Conclusion Compared with traditional incision drainage,the incision-thread-drawing procedure is more effective with less complications and lower recurrence rate,which should be the first choice for the treatment of perianal abscess.
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Objective To explore the effect of kangfuxin liquid topical treatment on open wound of postoperative perianal abscess.Methods200 cases of patients with open wound abscess surgery in our hospital from February 2014 to September 2016 were randomly divided into control group and experimental group,with 100 cases in each group.The control group was given conventional treatment, the experimental group were treated by kangfuxin liquid.The relevant therapeutic indicators and clinical healing time between two groups were compared.ResultsThe effective rate of the treatment group was 93.0%, which was significantly higher than that of the control group (85.0%), the difference was statistically significant(P<0.05).The granulation growth period of the experimental group was (5.14±1.41) days, and the average healing time was (15.21±2.49) days.Which were significantly shorter than those of the control group[(7.45±1.32) days, (21.16±2.69) days], and the differences were Statistical differences (P<0.05).ConclusionTo improve the treatment effect to a great extent open wound infection of kangfuxin liquid in treatment of perianal abscess after surgery, shorten the healing time, improve the patient's symptoms, with further clinical promotion and application significance.
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Objective To observe the effect of saline gauze tamponade of calculus bovis sativus on the level of IL-6 and IL-8 in the tissue of patients with perianal abscess after operation,and to explore its possible mechanism of action in promoting wound healing.Methods Patients with 84 cases of anal abscess surgery,were randomly divided into treatment group(n=42)and control group(n=42).Treatment group calculus bovis sativus research pressed into powder,take 0.10~0.15g evenly scattered in the saline gauze on the wound packing,the control group was treated with physiological saline gauze wound.After treatment,3,7 and 10d were treated with local granulation tissue about 0.2cm×0.2cm×0.1cm size,the IL-6 and IL-8 cytokines in local tissues were detected by enzyme-linked immunosorbent assay.Results There was no significant difference in the expression of IL-6 and IL-8 between the two groups 3 days after treatment(P>0.05),IL-6 and IL-8 in the treatment group(7,10d)were significantly lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion Calculus bovis sativus in the treatment group,IL-6 and IL-8 levels were significantly lower than those of the control group,indicating that calculus bovis sativus can reduce local inflammation response,promote healing of wound after perianal abscess operation.
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Objective To evaluate the clinical characteristics and the clinical outcomes of perianal abscess (PA) in neonates.Methods A retrospective review was performed on the collected data of 185 patients of PA in neonates prospectively admitted to Binzhou Medical University Hospital from January 2008 to December 2015.Patients were divided into 2 groups on the parents' intention:nonsurgical treatment and surgical treatment,the standard surgical treatment for PA was incision and drainage with the use of packing.The standard surgical treatment for PA was surgical incision drainage of lower abscess under local anesthesia by the use of filling tamponade iodoform gauze,while the patients receiving conservative treatment took hip bath perianally with topical 1 ∶ 5 000 potassium permanganate,besmearing erythromycin eye ointment outside locally.Incision-thread-drawing procedure was recommended in fistula-in-ano (FIA) after 6 months.Antibiotics were administered in all patients in the early days.The clinical data of age,gender,accompanying diseases,abscess amount and location,treatment approach,healing time and recurrence rates were analyzed with statistical method.Results All patients were boys,time of visiting hospital was 1-25 day,the average time 7.5 days;60 cases (32.4％)had neonatal diarrhea,45 cases (24.3％)had neonatal jaundice,but no patients had severe fever.A single skin lesion was present in 145 patients (78.4％),2 lesions in 30 patients (16.2％),and 10 patients had 3 lesions (5.4％).The most commonly affected sites were at 9 o'clock clockwise direction with 115 (62.2％)lesions on lithotomy position,followed by 3 o'clock clockwise direction with 65(35.1％) lesions by 1 o'clock clockwise direction with 3 (1.6％) lesions and 6 o'clock clockwise direction with 2 (1.1％) lesions.Bacteria cultures were obtained from 123 patients (90.4％,123/136 cases) of surgical treatment and 35 patients (71.4％,35/49 cases) of nonsurgical treatment obtained the results of bacteria culture.The average healing time was (21 ±2) days (10-60 days) in the surgical treatment group,and (36 ± 3) days (9-90 days) in the nonsurgical treatment group,7 out of 136(5.1％) patients had a recurrence with surgical treatment,incision drainage was performed again with the use of packing,and FIA was not found,10 out of 49 (20.4％) patients had a recurrence with nonsurgical treatment group,and 6 out of 49 (12.2％) were spontaneously resolves within the first year of life,4 out of 49 (8.1％) developed into FIA,incision-thread-drawing procedure was performed after 6 months.The significant difference was observed between and nonsurgical treatment and surgical treatment in healing time (t =-6.707,P =0.000),recurrence (x2 =11.347,P =0.001) and FIA formation rate (x2 =10.054,P=0.002).Conclusions PA is an entity in neonates.Incision and drainage of PA is an effective and safe therapy in the early days.Surgery for PA may result in low recurrence rates,a low rate of evolution toward FIA,and a short healing time,which should be considered as the primary treatment.The key procedure is to keep the drainage unobstructed by the use of filling gauze drainage to prevent crissum abscess recurrence.Postoperative care with antibiotics is effective to shorten hospital stays.
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Objective To observe the therapeutic efficacy of auricular point sticking in preventing pain after perianal abscess surgery.Method Sixty patients going to receive radical perianal abscess surgery admitted by the First Affiliated Hospitalof Guangzhou University of Chinese Medicine between December of 2015 and February of 2016 were enrolled and randomized into an ordinary group and an auricular point sticking group. Pain was scored at different time points after the surgery and the use of analgesics was also recorded.Result There were significant inter-group differences in comparing the pain intensity from 6 h after the surgery till 7:30 on the next day of the surgery (P0.05,P<0.05); the differences in pain intensity at the dressing change were statistical significant (P<0.05).Conclusion Auricular point sticking can effectively treat mild-moderate pain in the early stage after perianal abscess surgery at non-dressing-change time, and it can also produce a satisfactory effect in preventing moderate-severe pain at dressing change after perianal abscess surgery.
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Objective To observe the therapeutic efficacy of moxa smoke fumigation in promoting the wounds healing and improving the pain at dressing changes after perianal abscess surgery.Method A hundred eligible patients with perianal abscess were divided into a treatment group and a control group by the random number table, 50 cases in each group. The subjects all received dressing change from nurses of the Anorectal Department. In addition, the treatment group received moxa smoke fumigation at wounds for 30 min and the control group received microwave radiation at wounds for 30 min, both after dressing change, for a total of 14 times. The wounds-healed time, Visual Analogue Scale (VAS) scores on the day 1, 2, 3, 7, and 14 after the surgery, and Verbal Rating Scale (VRS) scores of the two groups were observed.ResultPatients in the treatment group took significantly shorter time to heal the wounds compared to those in the control group (P0.05), while the scores in the treatment group on day 2, 3, 7 and 14 were significantly lower than those in the control group (P<0.05); the VRS scores on day 1, 2, 3, 7, and 14 in the treatmentgroup were significantly lower than those in the control group (P<0.05).Conclusion Moxa smoke fumigation can promote the healing of the wounds after perianal abscess surgery, reduce the pain brought by dressing change, and this analgesic effect is consistent.
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Abstract Introduction Perianal suppurations have an incidence of 1-2:10,000 inhabitants per year and represent about 5% of proctology consultations, more frequently in males, being rare in childhood. Although perianal or anorectal abscess is an entity of relatively simple diagnosis and treatment, in a considerable percentage of patients difficulties will be found, especially considering that the initial treatment of these patients is performed by non-specialist physicians. Objective This is a retrospective survey of cases of perianal and anorectal abscess operated in Santa Marcelina Hospital between October 2011 and December 2014. Patients and methods A retrospective study of patients operated on an emergency basis for perianal and/or anorectal abscess in Santa Marcelina Hospital between October 2011 and December 2014, being excluded patients with inflammatory bowel disease. Data of gender, age, clinical presentation, the season of the year in which the abscess occurred, time of progression of symptoms, comorbidities, signs of Systemic Inflammatory Response Syndrome (SIRS) on admission, surgeries carried out, reoperations and clinical outcome were analyzed. Results Electronic medical records of 52 patients (73.1% male) who underwent surgical treatment of anorectal and perianal abscess were analyzed. The mean overall age was 43.03 years, and all patients reported pain as the main symptom, with a mean time of symptoms of 6.5 days. As for the season of the year of onset and diagnosis of perianal abscess, 61.5% of patients had this pathology in the summer and spring months. Conclusion In our study, it can be observed a higher incidence of perianal abscess in males and in the warmer months; furthermore, just over half of the patients developed perianal fistula in their progression.
Resumo Introdução As supurações perianais apresentam uma incidência de 1-2:10000 habitantes por ano e representam cerca de 5% das consultas proctológicas, com maior frequência no sexo masculino, sendo raras na infância. Embora o abscesso perianal ou anorretal seja de diagnóstico e tratamento relativamente simples, uma percentagem considerável representa maior dificuldade para tal, notadamente pelo fato do atendimento inicial desses pacientes ser realizado por médicos não especialistas. Objetivo Levantamento retrospectivo dos casos de abscesso perianal e anorretal operados no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014. Casuística e método Estudo retrospectivo de pacientes operados em caráter de urgência por abscesso perianal e/ou anorretal no Hospital Santa Marcelina entre outubro de 2011 e dezembro de 2014, excluídos portadores de doença inflamatória intestinal. Analisaram-se dados de sexo, idade, quadro clínico, época do ano da ocorrência do abscesso, tempo de evolução dos sintomas, comorbidades, sinais de Síndrome da Resposta Inflamatória Sistêmica (SIRS) na admissão, cirurgias realizadas, reoperações e desfecho clínico. Resultados Foram analisados prontuários eletrônicos de 52 pacientes submetidos à tratamento cirúrgico de abscesso anorretal e perianal, dos quais 73,1% pertenciam ao sexo masculino. A média de idade geral foi de 43,03 anos e todos os pacientes relataram dor como sintoma principal com média de tempo de sintomatologia de 6,5 dias. Quanto à época do ano do aparecimento e diagnóstico do abscesso perianal, 61,5% dos pacientes apresentaram a patologia nos meses de verão e primavera. Conclusão Em nosso trabalho, pode-se observar maior incidência de abscesso perianal no sexo masculino e nos meses mais quentes e que pouco mais da metade dos pacientes desenvolveram fístula perianal na evolução.
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Humans , Male , Female , Anus Diseases/epidemiology , Abscess/surgery , Abscess/epidemiology , Anal Canal/pathology , Rectal Fistula , Systemic Inflammatory Response SyndromeABSTRACT
OBJECTIVE:To compare economical efficiency of 4 therapeutic regimens for pediatric perianal abscess. METH-ODS:By retrospective study method,85 children were divided into group A(18 cases),B(10 cases),C(14 cases)and D(43 cases)according to different therapeutic regimens. They were given amoxicillin-flucloxacillin,flucloxacillin,cefathiamidine and ce-famandole 100 mg/(kg·d) intravenously for 5-7 d,respectively. Clinical efficacies and the occurrence of ADR were compared among 4 groups. The economical efficiency of 4 therapeutic regimens were analyzed by the method of cost-effectiveness analysis. RESULTS:For group A,B,C and D,the cure rates were 77.78%,80.00%,57.14% and 90.70%,that of group C was signifi-cantly lower than those of other 3 groups,with statistical significance(P<0.05). No significant ADR were found in 4 groups. The costs were 3 600.86,2 913.92,3 416.19 and 2 981.97 yuan,and the cost-effectiveness ratios were 46.30,36.42,59.79 and 32.88. The incremental cost-effectiveness ratios of group A,C and D to group B were -309.43,-21.97 and 6.36. The results of cost-ef-fectiveness analysis were supported by sensitivity analysis. CONCLUSIONS:For pediatric perianal abscess,cefamandole shows the best cost-effectiveness;but the therapeutic duration and total cost of flucloxacillin therapeutic regimen is shorter and lower. Thera-peutic regimen should be selected according to children’s condition.
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Klebsiella pneumoniae (K. pneumoniae) can at times cause invasive infections, especially in patients with diabetes mellitus and a history of alcohol abuse. A 61-year-old man with diabetes mellitus and a history of alcohol abuse presented with abdominal and anal pain for two weeks. After admission, he underwent sigmoidoscopy, which revealed multiple ulcerations with yellowish exudate in the rectum and sigmoid colon. The patient was treated with ciprofloxacin and metronidazole. After one week, follow up sigmoidoscopy was performed owing to sustained fever and diarrhea. The lesions were aggravated and seemed webbed in appearance because of damage to the rectal mucosa. Abdominal computed tomography and rectal magnetic resonance imaging were performed, and showed a perianal and perirectal abscess. The patient underwent laparoscopic sigmoid colostomy and perirectal abscess incision and drainage. Extended-spectrum beta-lactamase-producing K. pneumoniae was identified in pus culture. The antibiotics were switched to ertapenem. He improved after surgery and was discharged. K. pneumoniae can cause rapid invasive infection in patients with diabetes and a history of alcohol abuse. We report the first rare case of proctitis and perianal abscess caused by invasive K. pneumoniae infection.
Subject(s)
Humans , Middle Aged , Abscess , Alcoholism , Anti-Bacterial Agents , Ciprofloxacin , Colon, Sigmoid , Colostomy , Diabetes Mellitus , Diarrhea , Drainage , Exudates and Transudates , Fever , Follow-Up Studies , Klebsiella pneumoniae , Magnetic Resonance Imaging , Metronidazole , Mucous Membrane , Pneumonia , Proctitis , Rectum , Sigmoidoscopy , Suppuration , UlcerABSTRACT
Objective To study the clinical efficacy of self-made Shengji ointment on wound healing of postoperative perianal abscess. Methods 80 hospitalized patients with simple low anal abscess after surgery were randomly divided into control group and treatment group according to random digital table method, 40 cases in each group.The self-made Shengji ointment was smeared perianally and covered with gauze in treatment group, and Mayinglong shexiang zhichuang ointments was smeared perianally and covered with gauze in control group.VAS pain score and the granulation tissue scoring criteria were used to evaluate the growth status of the granulation.Results The VAS score in two groups were lower on the 3rd, 7th and 15th day than that on the 1st day (P<0.05);the VAS score on 1st day of two groups had no statisticall significant difference, but the VAS score in the treatment group were significantly lower than that in control group on the 3rd, 7th and 15th day, respectively (P<0.05).Duration of pain in treatment group was significantly lower than that of control group (P<0.05).The granulation tissue score in two groups on the 3rd, 7th and 15th day were lower than that on the 1st day,respectively (P <0.05); the granulation tissue score on the 1st day of two groups had no statistically significant difference, but the granulation tissue score in treatment group on the 3rd, 7th and 15th day were significantly lower than that in control group, respectively(P <0.05). Conclusion Self-made Shengji ointment could significantly relive the pain in wound, and promote the growth of granulation tissue, which has better effect in the treatment of wound healing of postoperative perianal abscess than Mayinglong shexiang zhichuang ointments.
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Objective To discuss the best method to treat deep perianal abscess and to investigate the clinical efficacy and value of the procedure of percutaneous catheter drainage guided by ultrasound in treatment.Ninteen patients with deep abscess underwent the procedure from Jan.2012 to May.2013.Methods Clinical data of 19 patients were analyzed retrospectively,including 16 male cases and 3 female cases.Results The average age is 39.8.All patients were cured without complications.The average length of stay is 7.8 days,a mean follow-up of 6.6 months after discharge,no patient with recurrence or fistula.Conclusion No specific performance of colorectal carcinoid,surgical resection is the most effective method of the treatment of colorectal carcinoid,the procedure should be individual treatment.However,the long term prognosis need to be explored in the future.
ABSTRACT
Objective To evaluate the Chinese decoction prescriptions combined with incision drainage operation in treatment of perianal abscess after leukemia chemotherapy.Methods One hundred cases of perianal abscess after leukemia chemotherapy were randomly divided into two groups,treatment group (Chinese decoction prescriptions combined with incision drainage operation) and control group (potassium permanganate combined with incision drainage operation).Observe and record the efficacy and ache alleviated after treatments,recurrences were followed up in and 3 years.Results After the treatments,the total effective rate was 90.0％ in the treatment group,significantly more than control group(72.0％),the difference was significant(x2 =10.52,P ＜ 0.05).And treatment after a week the VAS score in the treatment group and control group were(2.2 ± 0.4) and(4.7 ± 1.2),(t =14.62,P ＜0.05).The healing time were(13.4 ±9.3) d and(19.8 ±11.6) d,(t =4.95,P ＜ 0.05).After 3 years follow-up the recurrence rate and fistula formation rate in the treatment group and control group were 2.0％ and 2.0％,22.0％ and 26.0％,(x2 =18.93 and 23.92,P ＜ 0.01).Conclusion Chinese decoction prescriptions could collaborative incision drainage operation treatment of perianal abscess after leukemia chemotherapy,effective and safe,suitable for extensive application and promotion.