2020年10月27日星期二

preparation h hemorrhoids,A misdiagnosis caused by a date nucleus

    Clinically, I can often encounter some elderly people who feel dull and swallow the jujube nuclei when drinking porridge, which causes the jujube nucleus to get stuck in the anus and cannot be discharged. They come to see a doctor because of severe anal pain.

    On the first day of work after the Spring Festival, the department was extremely busy. 24 patients were admitted a day, including a female patient in her 40s. She had difficulty walking due to pain in the anus and restricted her sitting position. She found it during anal examination. A hemorrhoid was prolapsed at 9 o'clock on the right side of the anus. Because of the severe pain, the intra-anal digital examination could not be performed. After being admitted to the hospital, the examination was completed to eliminate the contraindications for surgery, and he was treated with local anesthesia in the emergency department in the afternoon.

    After the local anesthesia takes effect, prepare to sterilize the anal canal, push away the hemorrhoids at 9 o'clock, and find a two-pointed jujube nucleus stuck laterally on the edge of the anus. Asking the patient, the patient replied that it was the jujube nucleus that he had eaten last night, and he did not feel it at that time. Before the jujube nucleus was eaten, the anus had already prolapsed and the pain was severe. During the operation, pay special attention to check whether the anal mucosa is stabbed by the jujube nucleus. If it is stabbed, the wound should be incised to prevent local infection from forming an abscess. As a result, no obvious puncture wound was found, so his 9-point hemorrhoids were removed, and he was returned to the ward after the operation, and antibiotic infusion was given to prevent infection.

    In the next two days, pay special attention to whether the patient's anal pain is reduced, whether the wound is red and swollen, the patient complains that the pain is reduced, the wound has no obvious change, and the hemorrhoid wound is healing. On the third day after the operation, the patient suddenly developed fever, with a body temperature of about 38 degrees Celsius. Qingkailing was administered orally. The temperature was unstable and the fever was not completely relieved. At that time, it was considered that the patient caught cold while going to the toilet; the patient suddenly urinates on the fourth day after the operation. Difficulty, keep the catheterization; the patient was operated on Monday afternoon, and I was on duty on Saturday. When changing the dressing, I found that the patient was supported by his family to the dressing room. The pain was severe and the expression was painful. The patient complained of severe anal pain. Check the wound. There is no obvious redness and swelling on the surface, and there seems to be tenderness on the upper right side of the anus, which is not obvious. Because the patient is on the fifth day after the operation, he is at the peak of pain in the wound after anorectal disease, but he still feels that the patient should not have such pain. Resolutely give blood routine review and perianal color Doppler ultrasound exploration. Results Routine blood examination showed that both white blood cells and neutrophils were higher than those on admission. Color Doppler ultrasound showed that the subcutaneous 1.5cm is not homogeneous, considering the formation of abscess. Therefore, considering the complicated perianal abscess, after fully communicating with the patient and family members, the perianal abscess incision and drainage was performed under general anesthesia in the afternoon of the same day. During the operation, it was found that there was an ulcerated surface near the 5 o'clock position of the anal margin. There was yellow thick pus overflowing, and the abscess cavity was explored after the incision was made. The abscess cavity spread to around 10 o'clock on the right side of the anus. He was treated with incision and thread-hanging catheter. On the second day after the operation, the patient's body temperature returned to normal and the pain was relieved.

    The lesson learned from this case is that once the jujube nucleus is found stuck in the anal orifice in clinical work, the intestinal mucosa must be checked repeatedly, especially near the tooth line. The two ends of the jujube-nucleus are sharp and the muscles of the anal orifice are tense, which makes it easy to puncture. Injure the mucous membrane. In clinical work, carelessness is not tolerated, and care must be taken at every step. Finally, use a sentence that I don't remember which big doctor once said: If a doctor says that he has not had a single error in the operation, it is because he has not done enough.

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