Perirectal abscess incision and one-stage suture

Anal perianal abscess incision and primary suture for the treatment of anal canal and rectal abscess. An acute suppurative infection occurs in the soft tissue around the anorectal rectum or in the interstitial space, and an abscess is formed, which is called an anorectal abscess. It is characterized by ulceration or anal fistula after surgical incision and drainage. Common pathogens are Escherichia coli, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa, and occasionally anaerobic bacteria and Mycobacterium tuberculosis. However, it is often seen that a variety of pathogens are mixed infections. If the abscess around the anorectal rectum comes from the anal gland, an anal fistula is formed, which is the most common clinical. If the infection of the lesion does not originate from the anal gland, it will not form an anal fistula. This is a minority. Such as abscess can be directly derived from anal fissure, thrombotic external malleolus rupture, internal hemorrhoids or rectal prolapse drug injection, can also be derived from perianal skin infection, sepsis, blood disease or direct trauma, a few cases can also be derived from tuberculosis, ulcerative Colitis or Crohn's disease, etc. Due to the upward opening of the anal sinus, the feces easily enter or damage the anal sinus and cause infection. Infection can enter the anal gland along the anal duct, and spread through the tubular branches of the gland or the longitudinal muscle fibers to the upper, lower and outer parts of the anorectal space to form abscesses of various parts. Such as along the longitudinal muscles down to the anal canal opening for the perianal abscess, which is the most common abscess; outward through the combined longitudinal and external sphincter to the ischial rectal space into the ischial rectal abscess; up to the sphincter gap Pelvic rectal abscess. Treatment of diseases: perianal abscess Indication Anal perianal abscess incision and primary suture are mainly used for superficial perianal abscess and ischial rectal abscess. Contraindications Deep abscesses and combined internal hemorrhoids are not applicable. Preoperative preparation High-dose broad-spectrum antibiotics should be given before surgery and imported from the vein before anesthesia Surgical procedure Incision Radial incision abscess. 2. Exploring First use the finger to probe the abscess, and then use the probe to find out whether there is an internal fistula, the latter should not use this method. 3. Scraping The sharp wall is scraped off with a sharp curette. The scraping can destroy the granulation tissue layer of the abscess wall, facilitating the penetration of antibiotics from the blood circulation into the wall of the abscess for sterilization purposes. 4. Stitching Use the non-absorbent suture to make the skin a 3 or 4 needle vertical suture. The wound was slightly brazed with dry gauze. complication Abscess recurrence is a major complication of this procedure. One patient used a suture method to treat 100 cases of anorectal abscess, and followed up for 2 years, 15 cases of abscess recurrence, 7 cases of anal fistula, so the recurrence rate was 22%, the recurrence rate was related to the abscess category, such as the perianal abscess was 15.6 %, while the ischial rectal abscess was 33.3%.

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