2020年11月22日星期日

preparation h hemorrhoids,A misdiagnosis caused by a date nucleus

    Clinically, I often encounter some elderly people who feel dull and swallow the jujube nucleus when drinking porridge, which causes the jujube nucleus to get stuck in the anus and cannot be discharged, and comes 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 prolapsed from the right side of the anus at 9 o'clock. The patient was in severe pain and could not perform an intra-anal digital examination. After being admitted to the hospital, the examination was perfected, the surgical contraindications were excluded, and the emergency department underwent surgical treatment under local anesthesia 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 jujube nucleus with two pointed ends that are 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 the time. Before the jujube nucleus was eaten, the anus had 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 returned to the ward after the operation, and was given antibiotic infusion 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 does not change significantly, 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, the patient was considered to be 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. During the dressing change, the patient was helped by his family to the dressing room. The pain was severe and the expression was painful. The patient complained of severe anal pain. 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 in the peak period of pain after the anorectal disease operation, but 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 abscesses. 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 it is found that the jujube nucleus is stuck in the anal orifice in clinical work, it is necessary to check the intestinal mucosa repeatedly, especially near the tooth line. The two ends of the jujube-nucleus are sharp and the muscles of the anal orifice are tense, and it is 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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