The posterior rectal space abscess is a deep abscess above the levator ani muscle and is relatively rare. It is mostly caused by anal gland abscess piercing backward into the posterior space of the rectum. It can also be caused by proctitis, rectal ulcer, and rectal trauma. Common pathogenic bacteria are Escherichia coli, Staphylococcus aureus, Streptococcus and Pseudomonas aeruginosa, and occasionally anaerobic bacteria and Mycobacterium tuberculosis are often caused by mixed infections of multiple pathogens.
It is mostly caused by the anal gland abscess piercing back into the posterior rectum space, and can also be caused by proctitis, rectal ulcer, and rectal trauma.
Anal carbuncle is called anal carbuncle in Chinese medicine. The disease is caused by overeating spicy, fatty, sweet, alcoholic and other things, which damages the spleen and stomach, damp and heat endogenous, and is injected into the large intestine to accumulate and block the anus; or the anus is damaged and contaminated, causing meridian obstruction and stagnation of qi and blood; Or the lung and kidney yin deficiency, damp-heat phlegm turbidity bet, condenses the anus, stagnation of heat for a long time wins over meat rot, the disease develops.
Symptoms are similar to pelvic and rectal abscess, but there is a significant sense of rectal swelling in the rectum, dull pain can occur in the sacrum, and can radiate to the lower limbs, and there is obvious deep tenderness between the coccyx and anus. May be accompanied by symptoms of systemic poisoning, such as fever, chills, and general fatigue.
There is obvious deep tenderness between the tailbone and the anus, and the intestinal wall behind the rectum has tenderness, swelling, and undulation during digital anus examination. If necessary, do rectal ultrasound or CT examination to confirm. If an extrarectal mass is found, the differential diagnosis should consider presacral cysts, lipomas, teratomas, etc.
1. May be accompanied by chills, fever, general malaise and other symptoms. Anal burning or throbbing pain, aggravated when defecation or walking, a few have difficulty urinating.
2. Increased white blood cell and neutrophil count.
3. There are induration or lumps around the anus, local temperature increase, tenderness or fluctuation. For abscesses located above the levator ani muscle, a tender mass can be palpable on digital rectal examination, and pus can be extracted by intrarectal puncture.
1. Non-surgical treatment
① Antibiotic treatment: 2 to 3 kinds of antibiotics that are effective against gram-negative bacilli can be used in combination; ② warm water bath; ③ local physical therapy; ④ oral laxatives or paraffin oil to relieve pain during defecation.
2. Surgical treatment
Abscess incision and drainage is the main method for the treatment of posterior rectal abscess. Once the diagnosis is clear, incision and drainage should be done early. Deep drainage behind the anus is required, and the inner mouth is mostly located in the posterior middle. Low incision and high thread hanging + hose drainage combined with the "two-way isostatic drainage" theory can not only achieve the goal of one-time radical cure, but also reduce pain, shorten healing time, protect anal function and appearance, and reduce postoperative anal deformation and function Risks of damage and even incontinence.
1. Primary healing
After the onset of the disease, it should be removed and drained as soon as possible; accurately find and deal with the infection of the anal recess (ie the internal mouth), and it can achieve primary healing. If there is no anal fistula, there is no need for another operation.
2. Multiple operations
After the anal fistula is incised and drained in stages, or the internal mouth cannot be completely treated in a one-time radical operation, and eventually a high anal fistula is formed, another operation is required.
3. Systemic infection
For example, systemic infections caused by abscesses in the posterior rectal space cannot be treated early and promptly, which can eventually lead to systemic sepsis and sepsis, and even life-threatening. Delays in diagnosis and treatment (mostly delayed by more than 1 week) and related diseases (diabetes, obesity, malignant tumors, AIDS, combined and immune damage) are the main factors leading to systemic infections.
Keep the stool unobstructed, and pay attention to clean anus. Eat less spicy, fatty, sweet, alcoholic wine, etc.; live a regular life, avoid staying up late and overwork; actively treat related diseases, such as anal sinusitis, proctitis, etc.; treat as soon as possible after illness to prevent the expansion of the disease.
Department of Anorectal, Tongchuan District Hospital of Traditional Chinese Medicine, Dazhou City