Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pu...Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.展开更多
Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses w...Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.展开更多
BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE S...BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.展开更多
Perianal abscess is a common disease in anorectal surgery. If the diagnosis is not clear and the cure is thoroughly cleared, the recurrence and spread of anal fistula will cause life-long pain. Objective: To investiga...Perianal abscess is a common disease in anorectal surgery. If the diagnosis is not clear and the cure is thoroughly cleared, the recurrence and spread of anal fistula will cause life-long pain. Objective: To investigate the application of 3.0T MRI 3D CUBE T2WI lipid suppression sequence in the diagnosis of perianal abscess. Methods: Thirty-six patients with perianal abscess confirmed by operation were examined with 2D T2WI and 3D CUBE T2WI lipid suppression sequences before operation. Two imaging techniques were evaluated to show the types of perianal abscess, the number of abscesses, the number of internal orifices of abscess, and the number of fistula branches with anal fistula in abscess. Results: Among 36 cases of perianal abscess, there were 5 cases of anal subcutaneous abscess, 12 cases of ischiorectal space abscess (8 cases complicated with anal fistula), 6 cases of posterior anal space abscess, 5 cases of anal sphincter abscess (3 cases complicated with anal fistula), 2 cases of high intermuscular abscess, 2 cases of rectal submucosal abscess, 3 cases of complex abscess (3 cases complicated with anal fistula), 1 case of misdiagnosis, 2D T2WI lipid suppression sequence and 3D CUBE T2WI suppression. The accuracy of lipid sequence abscess typing was 80.6% (29/36) and 88.9% (32/36), respectively, with no significant difference (P > 0.05). Thirty-six patients were surgically diagnosed as having 32 internal orifices, 68.8% (22/32) and 93.8% (30/32) of 2D T2WI and 3D CUBE T2WI lipid-suppressing sequences, respectively, with significant difference (P Conclusion: 3D CUBE T2WI lipid suppression sequence is superior to 2D T2WI lipid suppression sequence in the classification of perianal abscess, the number of internal orifices of abscess and the number of fistula branches of abscess complicated with anal fistula. It can also determine the number of internal orifices of abscess complicated with anal fistula, the number of fistula branches, the shape of primary and branch fistula and the relationship among pelvic floor muscle tissues. It can provide more accurate images for preoperative and intraoperative clinical surgery.展开更多
BACKGROUND Extranodal natural killer(NK) T-cell lymphoma(ENKTL), nasal type is a rare subtype of extranodal non-Hodgkin lymphoma characterized by vascular damage and necrosis. The lesions usually present in the nasal ...BACKGROUND Extranodal natural killer(NK) T-cell lymphoma(ENKTL), nasal type is a rare subtype of extranodal non-Hodgkin lymphoma characterized by vascular damage and necrosis. The lesions usually present in the nasal cavity and adjacent tissues, however, the disease originates from the gastrointestinal or genitourinary tract in 25% of cases. Since rectal involvement in ENKTL is rare, rectal symptoms in the course of ENKTL are often misdiagnosed and considered to be related to benign diseases such as rectal fistula or perianal abscess.CASE SUMMARY We report the case of a 24-year-old Han Chinese female who initially presented with a perianal abscess that was subsequently diagnosed as nasal type ENKTL.Due to typical perianal pain, perianal abscess was diagnosed and surgical incision and drainage were performed. After recurrent, severe anal hemorrhages leading to hypovolemic shock and multiple surgeries, a diagnosis of ENKTL was made. The patient's condition gradually deteriorated, and she died shortly after initiation of chemotherapy.CONCLUSION Systemic and neoplastic diseases should be included in the differential diagnosis of any potentially benign perianal abscess complicated with recurrent hemorrhages.展开更多
Perianal abscess is a common clinical disease.This disease progresses rapidly.Surgical treatment is the main clinical treatment.Postoperative pain,bleeding,and excessive exudate are often accompanied by slow postopera...Perianal abscess is a common clinical disease.This disease progresses rapidly.Surgical treatment is the main clinical treatment.Postoperative pain,bleeding,and excessive exudate are often accompanied by slow postoperative wound healing due to special anatomic site.The external treatment of traditional Chinese medicine has various treatment methods for perianal abscess after operation,and the results are quite effective.The treatment experience of various doctors in the past five years was summarized as follows.展开更多
Objective:To investigate the effect of a clinical nursing pathway and visual health education on patients with perianal abscesses was the objective of this study.Methods:Eighty patients with perianal abscesses undergo...Objective:To investigate the effect of a clinical nursing pathway and visual health education on patients with perianal abscesses was the objective of this study.Methods:Eighty patients with perianal abscesses undergoing in-patient surgical treatment(blinded for review)between December 2019 and November 2020 were divided randomly and evenly into a control group and an experimental group.The control group received routine nursing care,and the experimental group received visual health education nursing care.Digital pain scores,patient satisfaction scores,nursing quality scores,and scores measuring knowledge of perianal abscess disease for the two groups before and after nursing care were compared and analyzed.Results:The experimental group had visual analog scale(VAS)scores significantly lower than those of the control group(P<0.05).For total nursing satisfaction,the experimental group demonstrated a higher satisfaction rate(P<0.05).Clinical nursing quality scores were significantly higher in the experimental group than those in the control group(P<0.05).The perianal abscess disease-related knowledge scores after intervention were significantly higher in the experimental group than those in the control group(P<0.01).Conclusions:Visual health education nursing can help patients better understand and deal with perianal abscess disease.展开更多
Objective: To study the effect of calcium alginate dressing on the cytokine contents, collagen synthesis - degradation balance and apoptosis gene expression in the wound after perianal abscess surgery. Methods: Patien...Objective: To study the effect of calcium alginate dressing on the cytokine contents, collagen synthesis - degradation balance and apoptosis gene expression in the wound after perianal abscess surgery. Methods: Patients with perianal abscess who received surgical resection in the Eighth Hospital of Wuhan between May 2014 and February 2017 were selected and randomly divided into the group A who received calcium alginate dressing combined with kangfuxin solution and recombinant human epidermal growth factor for dressing change and the group B who received kangfuxin solution and recombinant human epidermal growth factor for dressing change. 3 d, 6 d and 9 d after dressing change, appropriate amount of wound tissue was collected to determine the expression of cytokines, collagen metabolites and apoptosis genes. Results: 3 d, 6 d and 9 d after dressing change, TGF-β1, Smad3, EGF and bFGF protein expression as well as Col-I, Col-II, Col-III, TIMP1 and TIMP2 protein expression in wounds of both groups of patients were increasing while Fas, FasL, Bax and Caspase-3 protein expression were decreasing, and TGF-β1, Smad3, EGF and bFGF protein expression as well as Col-I, Col-II, Col-III, TIMP1 and TIMP2 protein expression in wounds of group A were significantly higher than those of group B while Fas, FasL, Bax and Caspase-3 protein expression were significantly lower than those of group B. Conclusion: Calcium alginate dressing for wound dressing after perianal abscess surgery an increase the pro-proliferation cytokine expression, adjust the collagen synthesis - degradation balance and inhibit apoptosis, and it is conducive to wound healing.展开更多
Literatures on the distribution of bacteria in perianal abscess from different regions and at different times were systematically analyzed,and the distribution of pathogens in perianal abscess was meta-analyzed using ...Literatures on the distribution of bacteria in perianal abscess from different regions and at different times were systematically analyzed,and the distribution of pathogens in perianal abscess was meta-analyzed using STATA 12.0 statistical software.The results showed that the detection rate of Escherichia coli was 0.64(95%CI,0.54-0.74),Klebsiella pneumoniae was 0.13(95%CI,0.12-0.15),and Staphylococcus was 0.07(95%CI,0.04-0.10).展开更多
AIM:To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn's disease(CD).METHODS:Patients with perianal disease(abscesses,fistulas,rec...AIM:To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn's disease(CD).METHODS:Patients with perianal disease(abscesses,fistulas,recurrent fissures) were evaluated for underlying CD.Patients who had a negative work up,defined as a negative colonoscopy with a normal ileoscopy or a normal small bowel series or a normal CT/MR enterography,underwent a Pillcam study of the small bowel after signing informed consent.Patients using nonsteroidal anti-inflammatory drugs or who had a history of inflammatory bowel disease or rheumatic disease were excluded.RESULTS:We recruited 26 patients aged 21-61 years(average 35.6 years),17 males and 9 females.One case could not be evaluated since the capsule did not leave the stomach.In 6 of 25(24%) patients with a negative standard work up for Crohn's disease,capsuleendoscopy(CE) findings were consistent with Crohn's disease of the small bowel.Family history of CD,white blood cell,hemoglobin,erythrocyte sedimentation rate or C-reactive protein did not predict a diagnosis of CD.Capsule endoscopy findings led to a change in treatment.CONCLUSION:In patients with perianal disease and a negative conventional work up to exclude CD,CE leads to incremental diagnostic yield of 24%.展开更多
Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the m...Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.展开更多
BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body...BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported.The most common sites of impaction and perforation include the appendix,cecum and the terminal ileum.The rectum is an unusual site of foreign body impaction.This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported.Both cases are infants with free previous medical history suffered from recurrent perianal infection.The caregivers of the two patients denied ingestion of a foreign body or any history of trauma.Physical examination combined with ultrasound or computed tomography scan established the diagnosis.Both of the patients underwent operation under general anesthesia.In case 1,a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula.The jujube pit was then removed intact along with fistula resection.The wound was successfully laid open to allow healing by secondary intention.In case 2,a jujube pit was found with its sharp end puncturing the rectum,surrounded by pus and necrotic tissue.Subsequent incision and adequate drainage were performed.The whole jujube pit was then removed from the abscess cavity at the same time.Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit.The postoperative period was uneventful.At 1.5 year follow-up,no recurrent abscess or fistula were found in either patient.CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula,especially in young children.展开更多
BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infec...BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.展开更多
文摘Background:Anal fistula is a long-term disease characterized by a tubular structure with one end opening in the anorectal canal and the other end opening on the surface of the perineum or perianal skin with chronic pus drainage.It is linked to Bhagandar in Ayurveda,and in Sushruta Samhita,Acharya has mentioned 5 forms of Bhagandar.The boil in the present case was Shukla,sthira i.e.hard and firm,with Picchila strava and Kandu resembling the features of Parisraavi bhagandar.Aim and objective:The current case was diagnosed as Parisravi bhagandar,which resembles trans-sphincteric or intersphincteric fistula in modern ano.In Ayurveda,the management of Parisraavi Bhagandar,Shastra,kshara,and Agnikarma is advised and the use of Ksharasutra,which contributes to complete cutting and healing of the track without reoccurrence,similarly Modern surgeon depends on surgery i.e radical excision of the track,ligation with Seton,and use of chemical irritants like urethane,silver nitrates,etc.A cutting seton(tight)gently slices the confined muscle to close the fistula with the least interruption to continence.This operation is especially advised when a one-stage fistulotomy poses a considerable risk of incontinence.Material and methods:The method performed here was Core Partial Fistulectomy followed by Ksharasutra application till complete healing of the wound.Discussion and conclusion:This case study provides the successful management of Parisraavi Bhagandara(high anal,trans-sphincteric fistula in ano)in 61-year-old male patient with an integrated surgical&Ayurvedic management approach.
文摘Objective:To explore the effect of the Xian Fang Huo Ming Yin(XFHM)for treating cutaneous infections and promoting wound healing in patients with perianal abscesses.Methods:Sixty-one patients with perianal abscesses who were admitted to our hospital(Xinghua City People’s Hospital)from May 2022 to May 2023 were selected and randomly divided into two groups,a control group(30 cases)and a study group(31 cases).Both groups received surgical treatment.The control group received conventional treatment and warm water fumigation,sitz bath,and surgical dressing change after surgery,while the research group received XFHM based on the control group.XFHM was taken orally and replaced with warm water for fumigation and sitz bathing.Both groups received treatment for 4 weeks but discontinued sitz bathing after 2 weeks.Various clinical indicators between the two groups were compared.Results:The total clinical effective rate and wound recovery rate of the study group were higher than that of the control group.There were differences in the wound pain scores,surrounding tissue edema,and wound secretions at different time points.Both groups experienced wound pain.The scores of wound pain,surrounding tissue edema,and wound secretions of the study group were lower than those of the control group,7 and 14 days after surgery.The serum interleukin 6(IL-6),tumor necrosis factor-alpha(TNF-α)levels,and pH values of the study group were lower than those of the control group 10 days after surgery(P<0.05).Conclusion:The application of XFHM for treating cutaneous infections and promoting wound healing in patients with perianal abscesses improved the treatment outcome,alleviated clinical symptoms,and promoted healing.
基金Supported by the National Key Research and Development Program of China,No.2021YFC2009100Included in the information database of“Pelvic Diaphragm Health Archives”,No.2021YFC2009103.
文摘BACKGROUND Chronic myelomonocytic leukemia(CMML)complicated with Sweet syndrome(SS)is a rare hematological neoplasm.However,cases of concomitant development of perianal necrotizing SS(NSS)have not been reported.CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess.He developed postoperative incision infection and was referred to the department where the authors work.Initially,perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected.Despite receiving antibiotic therapy and undergoing surgical debridement,deeper necrotic areas formed in the patient’s perianal wounds,accompanied by persistent high fever.Blood and fungal cultures yielded negative results.The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.CONCLUSION CMML with perianal NSS is a rare condition,often misdiagnosed as perianal abscess or perianal necrotizing fasciitis.Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
文摘Perianal abscess is a common disease in anorectal surgery. If the diagnosis is not clear and the cure is thoroughly cleared, the recurrence and spread of anal fistula will cause life-long pain. Objective: To investigate the application of 3.0T MRI 3D CUBE T2WI lipid suppression sequence in the diagnosis of perianal abscess. Methods: Thirty-six patients with perianal abscess confirmed by operation were examined with 2D T2WI and 3D CUBE T2WI lipid suppression sequences before operation. Two imaging techniques were evaluated to show the types of perianal abscess, the number of abscesses, the number of internal orifices of abscess, and the number of fistula branches with anal fistula in abscess. Results: Among 36 cases of perianal abscess, there were 5 cases of anal subcutaneous abscess, 12 cases of ischiorectal space abscess (8 cases complicated with anal fistula), 6 cases of posterior anal space abscess, 5 cases of anal sphincter abscess (3 cases complicated with anal fistula), 2 cases of high intermuscular abscess, 2 cases of rectal submucosal abscess, 3 cases of complex abscess (3 cases complicated with anal fistula), 1 case of misdiagnosis, 2D T2WI lipid suppression sequence and 3D CUBE T2WI suppression. The accuracy of lipid sequence abscess typing was 80.6% (29/36) and 88.9% (32/36), respectively, with no significant difference (P > 0.05). Thirty-six patients were surgically diagnosed as having 32 internal orifices, 68.8% (22/32) and 93.8% (30/32) of 2D T2WI and 3D CUBE T2WI lipid-suppressing sequences, respectively, with significant difference (P Conclusion: 3D CUBE T2WI lipid suppression sequence is superior to 2D T2WI lipid suppression sequence in the classification of perianal abscess, the number of internal orifices of abscess and the number of fistula branches of abscess complicated with anal fistula. It can also determine the number of internal orifices of abscess complicated with anal fistula, the number of fistula branches, the shape of primary and branch fistula and the relationship among pelvic floor muscle tissues. It can provide more accurate images for preoperative and intraoperative clinical surgery.
基金Supported by the Nanjing Health Bureau Project,No.ZKX17034Nanjing Traditional Chinese Medicine of Medical Conversion Base,No.ZHZD201802The 13~(th) Five-Year Plan for Training Young Health Personnel in Nanjing,No.NWQR-201702
文摘BACKGROUND Extranodal natural killer(NK) T-cell lymphoma(ENKTL), nasal type is a rare subtype of extranodal non-Hodgkin lymphoma characterized by vascular damage and necrosis. The lesions usually present in the nasal cavity and adjacent tissues, however, the disease originates from the gastrointestinal or genitourinary tract in 25% of cases. Since rectal involvement in ENKTL is rare, rectal symptoms in the course of ENKTL are often misdiagnosed and considered to be related to benign diseases such as rectal fistula or perianal abscess.CASE SUMMARY We report the case of a 24-year-old Han Chinese female who initially presented with a perianal abscess that was subsequently diagnosed as nasal type ENKTL.Due to typical perianal pain, perianal abscess was diagnosed and surgical incision and drainage were performed. After recurrent, severe anal hemorrhages leading to hypovolemic shock and multiple surgeries, a diagnosis of ENKTL was made. The patient's condition gradually deteriorated, and she died shortly after initiation of chemotherapy.CONCLUSION Systemic and neoplastic diseases should be included in the differential diagnosis of any potentially benign perianal abscess complicated with recurrent hemorrhages.
基金Project of the National Administration of Traditional Chinese Medicine,ZYYS-2013(PJ67)Research on the revision of TCM clinical diagnosis and treatment guidelines for anorectal abscess+1 种基金Natural Science Fundamentals General Project of Shaanxi Provincial Department of Science and Technology,2020JM-588Study on the mechanism of simmering pus and flesh growing and curing from the correlation between damp-heat transforming and NF-kb/AQP pathway。
文摘Perianal abscess is a common clinical disease.This disease progresses rapidly.Surgical treatment is the main clinical treatment.Postoperative pain,bleeding,and excessive exudate are often accompanied by slow postoperative wound healing due to special anatomic site.The external treatment of traditional Chinese medicine has various treatment methods for perianal abscess after operation,and the results are quite effective.The treatment experience of various doctors in the past five years was summarized as follows.
基金supported by the First Affiliated Hospital of Huzhou Teachers College(No.2019GYB44)。
文摘Objective:To investigate the effect of a clinical nursing pathway and visual health education on patients with perianal abscesses was the objective of this study.Methods:Eighty patients with perianal abscesses undergoing in-patient surgical treatment(blinded for review)between December 2019 and November 2020 were divided randomly and evenly into a control group and an experimental group.The control group received routine nursing care,and the experimental group received visual health education nursing care.Digital pain scores,patient satisfaction scores,nursing quality scores,and scores measuring knowledge of perianal abscess disease for the two groups before and after nursing care were compared and analyzed.Results:The experimental group had visual analog scale(VAS)scores significantly lower than those of the control group(P<0.05).For total nursing satisfaction,the experimental group demonstrated a higher satisfaction rate(P<0.05).Clinical nursing quality scores were significantly higher in the experimental group than those in the control group(P<0.05).The perianal abscess disease-related knowledge scores after intervention were significantly higher in the experimental group than those in the control group(P<0.01).Conclusions:Visual health education nursing can help patients better understand and deal with perianal abscess disease.
文摘Objective: To study the effect of calcium alginate dressing on the cytokine contents, collagen synthesis - degradation balance and apoptosis gene expression in the wound after perianal abscess surgery. Methods: Patients with perianal abscess who received surgical resection in the Eighth Hospital of Wuhan between May 2014 and February 2017 were selected and randomly divided into the group A who received calcium alginate dressing combined with kangfuxin solution and recombinant human epidermal growth factor for dressing change and the group B who received kangfuxin solution and recombinant human epidermal growth factor for dressing change. 3 d, 6 d and 9 d after dressing change, appropriate amount of wound tissue was collected to determine the expression of cytokines, collagen metabolites and apoptosis genes. Results: 3 d, 6 d and 9 d after dressing change, TGF-β1, Smad3, EGF and bFGF protein expression as well as Col-I, Col-II, Col-III, TIMP1 and TIMP2 protein expression in wounds of both groups of patients were increasing while Fas, FasL, Bax and Caspase-3 protein expression were decreasing, and TGF-β1, Smad3, EGF and bFGF protein expression as well as Col-I, Col-II, Col-III, TIMP1 and TIMP2 protein expression in wounds of group A were significantly higher than those of group B while Fas, FasL, Bax and Caspase-3 protein expression were significantly lower than those of group B. Conclusion: Calcium alginate dressing for wound dressing after perianal abscess surgery an increase the pro-proliferation cytokine expression, adjust the collagen synthesis - degradation balance and inhibit apoptosis, and it is conducive to wound healing.
文摘Literatures on the distribution of bacteria in perianal abscess from different regions and at different times were systematically analyzed,and the distribution of pathogens in perianal abscess was meta-analyzed using STATA 12.0 statistical software.The results showed that the detection rate of Escherichia coli was 0.64(95%CI,0.54-0.74),Klebsiella pneumoniae was 0.13(95%CI,0.12-0.15),and Staphylococcus was 0.07(95%CI,0.04-0.10).
文摘AIM:To investigate the role of capsule endoscopy in patients with persistent perianal disease and negative conventional work up for Crohn's disease(CD).METHODS:Patients with perianal disease(abscesses,fistulas,recurrent fissures) were evaluated for underlying CD.Patients who had a negative work up,defined as a negative colonoscopy with a normal ileoscopy or a normal small bowel series or a normal CT/MR enterography,underwent a Pillcam study of the small bowel after signing informed consent.Patients using nonsteroidal anti-inflammatory drugs or who had a history of inflammatory bowel disease or rheumatic disease were excluded.RESULTS:We recruited 26 patients aged 21-61 years(average 35.6 years),17 males and 9 females.One case could not be evaluated since the capsule did not leave the stomach.In 6 of 25(24%) patients with a negative standard work up for Crohn's disease,capsuleendoscopy(CE) findings were consistent with Crohn's disease of the small bowel.Family history of CD,white blood cell,hemoglobin,erythrocyte sedimentation rate or C-reactive protein did not predict a diagnosis of CD.Capsule endoscopy findings led to a change in treatment.CONCLUSION:In patients with perianal disease and a negative conventional work up to exclude CD,CE leads to incremental diagnostic yield of 24%.
文摘Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.
文摘BACKGROUND About 90%of perianal infection is caused by cryptoglandular infection.Only a few cases of peritonitis or intra-abdominal abscesses secondary to perforation of the digestive tract by an ingested foreign body have been reported.The most common sites of impaction and perforation include the appendix,cecum and the terminal ileum.The rectum is an unusual site of foreign body impaction.This report intends to highlight that ingested foreign body impacted in the rectum is an extremely rare cause of perianal abscess and subsequent fistula in infants.CASE SUMMARY Two cases of perianal abscess and fistula due to ingested jujube pit impacted in the rectum are reported.Both cases are infants with free previous medical history suffered from recurrent perianal infection.The caregivers of the two patients denied ingestion of a foreign body or any history of trauma.Physical examination combined with ultrasound or computed tomography scan established the diagnosis.Both of the patients underwent operation under general anesthesia.In case 1,a jujube pit with sharp ends was discovered embedded within a subcutaneous fistula.The jujube pit was then removed intact along with fistula resection.The wound was successfully laid open to allow healing by secondary intention.In case 2,a jujube pit was found with its sharp end puncturing the rectum,surrounded by pus and necrotic tissue.Subsequent incision and adequate drainage were performed.The whole jujube pit was then removed from the abscess cavity at the same time.Both patients received colonoscopy to rule out inflammatory bowel disease or other potential damages by the ingested jujube pit.The postoperative period was uneventful.At 1.5 year follow-up,no recurrent abscess or fistula were found in either patient.CONCLUSION An impacted foreign body must not be overlooked as an unusual cause of perianal abscess and fistula,especially in young children.
文摘BACKGROUND Tailgut cyst is a congenital enterogenous cyst that rarely undergoes malignant transformation.Its clinical manifestations mainly correlate to the mass effect caused by the development of cysts and the infections that originate from these.Furthermore,the complete resection of this cyst is curative.We report our diagnostic and treatment experience with one case of malignant transformation of a perianal tailgut cyst,which was initially misdiagnosed as perianal abscess.CASE SUMMARY A 72-year-old woman visited our institution with complaints of a refractory nonhealing lesion on the right hip,which repeatedly broke and suppurated for more than 70 years,and aggravated in 4 mo.The patient was given a diagnosis of refractory perianal abscess with repeated incision and drainage procedures.Computed tomography of the pelvic cavity revealed a giant perianal cyst.Subsequent biopsy revealed a tumor with moderate-to-severe glandular epithelial dysplasia,and suggested that this was derived from the developmental cysts in the posterior rectal space.After further clarifying the nature and extent of the tumor by magnetic resonance imaging,total cystic resection was performed.Postoperative histopathological examination confirmed the malignancy,dictating the investigators to add postoperative chemotherapy to the treatment regimen.CONCLUSION The malignant transformation of perianal tailgut cysts is very uncommon,and this should be differentiated from perianal abscess.Complete surgical removal is curative,and postoperative pathology may determine the necessity of additional postoperative chemotherapy or radiotherapy,which may be beneficial for preventing local recurrence and metastasis.