Perianal abscess incision and drainage

After the crypt or anal nipple is damaged by the feces, the bacteria invade from the wound, causing crypts and milk inflammation. At the bottom of the crypt, there are many glandular tissues that are branched, so that the inflammation is not easy to absorb by itself. Instead, the spleen spreads outward along the muscle space around the anorectal, forming an abscess everywhere. There are 5 surgical anatomical spaces around the anorectal rectum, with the levator ani muscle as the boundary. There are two pelvic rectal spaces and one rectal posterior space, and there are two ischial rectal spaces. Abscesses can form in these gaps, and abscesses can form in the submucosal or perianal skin or under the skin. Abscess in the pelvic rectal space, if not in time to open the drainage, can be worn through the rectum, bladder, vaginal or ischial rectal space; the ischial rectal abscess can also bypass the anal canal before or after the contralateral side; rectal posterior abscess can be Penetrate into the abdominal or ischial rectal space. Treatment of diseases: anorectal abscess Indication A superficial abscess that is prone to fluctuations. Submucosal abscess is also easily detected by anal or digital proctoscopy. However, in the pelvic rectal space abscess above the levator ani muscle, if it is not penetrated into the shallow layer, it is impossible to find fluctuations. Only the skin on the side of the disease can be seen as red, edema, and induration. It must rely on puncture and pus to be diagnosed. . Once the rectum around the rectum is formed, it is not easy to absorb it by itself. Even if it is broken by itself, the drainage is not smooth. Therefore, once the diagnosis is confirmed, the drainage should be cut, and the incision should not be made until the fluctuation occurs, so that more tissues are subjected to unnecessary infection and necrosis. Contraindications Patients with coagulopathy. Preoperative preparation 1. No special preparation is required. 2. General anesthesia patients fasted 6 hours before surgery. 3. Skin preparation can be performed after anesthesia to reduce pain. Surgical procedure (1) perianal subcutaneous abscess incision and drainage Gravel or lateral position. A radial incision is made at the perianal abscess, the length of which is equivalent to the size of the abscess. After cutting the skin, use a hemostatic forceps to bluntly separate, enter the abscess, and drain the pus. Then, use your fingers to reach the abscess to detect the size and separate the fibers in the abscess. (If the subcutaneous sphincter subcutaneous group is obstructing drainage, you can cut it, but do not damage the deep layer). After expanding the incision as needed, cut the skin at the edge of the incision a little to make the drainage smooth. Finally, the necrotic tissue in the cavity was removed, and the vaseline was filled with Vaseline gauze. In order to avoid the formation of fistulas in the future, after the abscess is cut, the inflamed crypt (ie the inner mouth) should be sought, and the tissue between the incision and the incision should be cut open and drained smoothly. If the internal mouth is above the anorectal ring, it will not be cut. It is advisable to use staged surgery. You can use the silk thread to pass through the inner mouth for 2 to 3 weeks, and then cut it when the fistula is formed. (B) rectal submucosal abscess incision and drainage Abscess is located in the upper part of the rectum, no need to anesthesia; abscess close to the tooth line, because of pain sensitivity, it is appropriate to use local anesthesia or saddle anesthesia. Insert the anal hook and find the abscess. Use a sharp-edged knife to puncture the mucosa at the abscess bulge and drain the pus. Then use a hemostatic forceps to bluntly enlarge the incision (equal to the size of the abscess), remove the necrotic tissue, and do not drain. (three) sciatic rectal space abscess incision and drainage In the case of fluctuations, make a straight incision or a slightly curved incision. The incision is as close as possible to the anus, but at least 2.5 cm from the anus to avoid damage to the anal sphincter. After the skin is opened, the hemostatic forceps are used to bluntly divide into the abscess and the pus is discharged. Extend the index finger, explore the scope of the abscess, separate the fiber spacing in the abscess, and expand the incision in the forward and backward directions according to the extent of the abscess. The sciatic rectal space can accommodate 60-90 ml of pus. If the pus discharge exceeds 90 ml during operation, it should be considered to be connected with the contralateral rectal space or the pelvic rectal space above it, and must be drained after diagnosis. Trim the protruding wound edge. After stopping bleeding, place the Vaseline gauze strip for drainage. (four) pelvic rectal space abscess incision and drainage The operation is roughly the same as the incision drainage of the ischial rectal space abscess, but the incision must be biased to the posterior aspect of the anus, and cut obliquely 2.5 cm from the anal margin. When the hemostat is inserted into the ischial rectal space, the left hand is inserted into the rectum, and the hemostat is guided to the depth. When the hemostatic forceps reach the levator ani muscle, the muscle strength can be felt. After passing through the levator ani muscle with the tip of the forceps, continue to insert about 1cm, that is, there is pus out [Fig. 5 (1)]. Open the hemostat again and enlarge the drainage port on the levator ani muscle. After the pus is drained, the protruding edges on both sides of the wound edge are removed, and a cigarette drainage is built in the abscess. (5) rectal posterior space abscess incision and drainage After incision on the posterior aspect of the anus, use a finger to guide in the rectum, use a hemostatic forceps to separate the posterior and internal parts, enter the abscess, and drain the pus. After the hemostat was opened to expand the drainage port, the cigarette was drained.