Patient's question:
The child, who is two and a half months old, has been experiencing recurrent episodes of diarrhea. The duration and cause of the illness: It was diagnosed about one and a half months ago.Previous treatment and effectiveness: At the children's hospital, they used a knife to drain pus. What kind of assistance is needed: Is there any way to prevent the episodes from occurring...
Doctor's answer:
Recurrent acute purulent infection in the soft tissues around the rectum or in its surrounding spaces, forming an abscess, is termed anorectal abscess. It is characterized by spontaneous rupture or often leads to the formation of an anal fistula after surgical incision and drainage. It is a common anorectal disease and represents the acute phase of the anorectal inflammatory pathological process, while the fistula is the chronic phase. Common pathogens include Escherichia coli, Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. Occasionally, anaerobic bacteria and Mycobacterium tuberculosis are involved, and it is often a mixed infection of multiple different bacteria. Recently, it has also been discovered to be related to injuries around the anal line. Perianal subcutaneous abscesses are the most common, mostly resulting from the spread of infection from anal glands through the superficial external sphincter to the outside or directly outward.A very small number of perianal abscesses can be resolved with antibiotics, hot Sitz baths, and local physiotherapy, but most require surgical treatment. There are two methods for surgical treatment.
(1) For simple abscesses, treatment can be performed in the lithotomy or semi-recumbent position under local or spinal anesthesia. A radial incision is made at the abscess site to drain the pus. After draining the pus, the index finger is inserted to explore the size of the abscess cavity and to identify the septa. If necessary, a small portion of the skin around the incision margin may be incised to facilitate drainage. Finally, (Vaseline gauze) is placed into the abscess cavity for drainage.
(2) For abscesses connected to an anal fistula, after incising the abscess, a probe is used to carefully examine the internal orifice. The fistula is then incised, with appropriate excision of the skin and subcutaneous tissue. The surrounding tissue around the internal orifice is also slightly excised to ensure smooth drainage. If the internal orifice is deep and the fistula passes through the anal sphincter, the ligation method () can be used.
The advantage of these surgical methods is that the abscess heals spontaneously in one stage, preventing the formation of an anal fistula. However, during acute inflammation, if identifying the internal orifice is difficult, it should not be searched for blindly to avoid the spread of infection or the formation of a false tract. Only incision and drainage should be performed, and after the fistula forms, the fistula surgery can be done. The advantage of the two-stage surgery is that the effect is accurate and the cure rate is high.