2020年11月12日星期四

what does a hemorrhoids look like,A race against time: a case of acute and critical perianal necrotizing fasciitis surgery

    On July 31, under the leadership of the Xinjiang-aid expert Hong Zifu, our department successfully completed a case of perianal necrotizing fasciitis caused by perianal abscess in collaboration with multiple departments such as hand anesthesia, imaging, and ICU.

    Director Hong Zifu uses exquisite surgical techniques and actively treats patients to turn the patient's condition into safety and save lives. And to avoid the risk of secondary operations, greatly reducing the pain of patients.

    Perianal necrotizing fasciitis is a rare but extremely dangerous disease in clinical practice. It is an acute and critical illness in anorectal surgery. It is a soft tissue infection that causes progressive necrosis of the perineum, scrotum, perianal skin, subcutaneous tissue, and deep and superficial fascia caused by a variety of pathogenic bacteria. The incidence rate is extremely low. The annual incidence rate in the United States is about 4/100,000 (no statistics available in China), but the disease develops rapidly, spreading to surrounding tissues at a development speed of 2-3 cm/h, which can easily cause sepsis, For complications such as septic shock, respiratory failure, renal failure, and multiple organ failure, if surgery is not performed in time, the fatality rate is as high as 40%-74%.

    The next day, urgently contact the radiology department for CT plain scan + enhanced examination, considering the possibility of perianal acute necrotizing fasciitis. Emergency surgery is planned, and preparations are active. Emergency investigation: white blood cells 21.15E+09/L, C-reactive protein 358mg/L, procalcitonin 0.31ng/ml, plasma fibrinogen 9.88g/L (report critical value). The above results indicate severe infection. Combined with CT report, the diagnosis is clear: perianal abscess, perianal necrotizing fasciitis, immediately contact the operating room for emergency surgery.

    On physical examination: skin redness and swelling around the anus, local skin lesions, obvious pressing pain, and crepitus, redness spreading to the scrotum, about 10x5cm, obvious redness and swelling at the scrotum, painful pressing, crepitus, and local black blisters. The digital examination and the back of the anal straight ring were hard, and the pressing pain was obvious. The induration was palpable at the 6 o'clock tooth line. There was no blood or secretion on the finger cuff. The pain was not checked by microscopy.

    Check upon admission:

    CT results: It can be seen from the CT results that the perianal and subscrotal cavities have been completely formed, and the spread of infection is extremely wide, which is in line with the diagnosis of perianal necrotizing fasciitis. The patient’s condition has progressed less than 12 hours after admission. rapid.

    According to the needs of the condition, contact the operating room for emergency surgery.

    The key to surgical treatment is to remove the necrotic tissue and separate the incisions properly to ensure adequate drainage.

    The necrotic tissue is completely removed, and the wounds are penetrated by rubber bands to ensure sufficient drainage. The postoperative dressing change can alleviate the pain of the patient.

    After the successful operation, the small group photo and the postoperative director Hong check the patient:

    summary

    Perianal necrotizing fasciitis is a soft tissue infectious disease characterized by rapid and extensive necrosis of the fascia and subcutaneous tissue, and does not involve muscle tissue. Patients usually have symptoms of systemic poisoning. This disease is usually a mixed infection of aerobic bacteria and anaerobes that work together. The incidence is hidden and the misdiagnosis rate is high. Patients usually first have perianal and perineal swelling and pain. Local pressure can show subcutaneous crepitus, which develops with the disease. Subcutaneous and fascial necrosis can occur in a short time. Once diagnosed, treatment should be stopped in time.

    Traditional Chinese medicine believes that perianal necrotizing fasciitis belongs to the categories of "anal gangrene", "rotten furuncle", and "carbuncle invagination". It is more common in frail patients with trauma. It is mainly due to the weak body of the patient, the lack of righteousness, and the lack of solid health outside the body. Fire poison, the evil is prosperous and declining, the poison enters the inside, and the internal organs are trapped. If the fire poison is raging and enters the camp blood, it is easy to become yellowish and severe.

    Under the leadership of the Xinjiang-aid expert, Director Hong Zifu, and the active cooperation of multiple departments, despite the stench (the actual situation of the abscess incision), the surgical team finally completed this high-risk and rare operation after more than two hours of hard work. To keep the patient out of danger and successfully save lives.

    After the operation, combined with TCM syndrome differentiation and treatment, Chinese medicine decoction was given orally to clear away heat and detoxify, reduce swelling and dispel lumps, promote blood circulation and relieve pain, and combined with anti-inflammatory, nutritional support, routine dressing, traditional Chinese medicine fumigation and other treatment measures. The patient's condition gradually recovered and the surgical wound Healing day by day.

    Correspondent: Bai Bo

    Chinese Medicine

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