Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and man...Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis(Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.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
目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual...目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual analogue scale,VAS)、Wexner量表、健康调查简表(the MOS item short from health survey,SF-36)评价疼痛、肛门功能和生活质量比较两组患者治疗后的创面面积、治疗效果、肛门功能、生活质量、切口愈合时间和术后住院时间、术后后遗症。结果与对照组比较,观察组术后7 d、21 d创面面积较小;观察组术后3 d、7 d患者VAS评分、创面分泌物评分、创面肿胀度评分较低,肉芽生长情况评分较高;术后7、28 d Wexner量表评分较低;术后7 d的SF-36评分较高;切口愈合时间较短,组间差异均有统计学意义(P<0.05)。观察组后遗症发生率为5.0%(2/40),低于对照组的22.5%(9/40)(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论接受改良Hanley术联合拖线疗法可减轻坐骨直肠间隙肛周脓肿患者术后创面疼痛,缩短愈合时间,提高术后生活质量,减少后遗症的发生。展开更多
文摘Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis(Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
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.
文摘目的分析坐骨直肠间隙肛周脓肿患者采用改良Hanley术联合拖线疗法治疗的临床疗效。方法选取坐骨直肠间隙肛周脓肿患者80例,随机分为观察组(改良Hanley术联合拖线疗法)和对照组(切开内口挂线疗法),每组40例。分别采用视觉模拟评分(visual analogue scale,VAS)、Wexner量表、健康调查简表(the MOS item short from health survey,SF-36)评价疼痛、肛门功能和生活质量比较两组患者治疗后的创面面积、治疗效果、肛门功能、生活质量、切口愈合时间和术后住院时间、术后后遗症。结果与对照组比较,观察组术后7 d、21 d创面面积较小;观察组术后3 d、7 d患者VAS评分、创面分泌物评分、创面肿胀度评分较低,肉芽生长情况评分较高;术后7、28 d Wexner量表评分较低;术后7 d的SF-36评分较高;切口愈合时间较短,组间差异均有统计学意义(P<0.05)。观察组后遗症发生率为5.0%(2/40),低于对照组的22.5%(9/40)(P<0.05)。其余指标差异无统计学意义(P>0.05)。结论接受改良Hanley术联合拖线疗法可减轻坐骨直肠间隙肛周脓肿患者术后创面疼痛,缩短愈合时间,提高术后生活质量,减少后遗症的发生。