I took a closer look with her, and the appearance of the anus was not abnormal. There were only mild internal hemorrhoids under anoscope, and there was no ulceration or erosion of the rectal mucosa. Digital anal examination also showed no obvious hard and tenderness. Because this patient has been treated in many hospitals, I didn’t find it positive and I didn’t give up. Later, I showed her several times with an anoscope and finally discovered the new world. At the 6 o’clock point 1.5 cm from the anal margin, there was The outer mouth of the concealed anal fistula, touch it carefully, and walk under the mucous membrane!
There is a reason why the patient is misdiagnosed many times. Because the patient has a submucosal fistula, the drainage is relatively unobstructed, there is no obvious anal swelling, pain and pus, and the external mouth is very hidden. It is hard to find without anesthesia.
If the problem is found, it is easy to solve it, and it is enough to receive a rectal submucosal fistula incision.
I went to the ward round today. When the patient saw me, he smiled and said: "Doctor Li, I will never have anal pain again when I squat down." Actually, I am in a good mood. The smile of the patient after healing is our biggest motivation for practicing medicine!
There is no love for no reason, nor anal pain for no reason. Don’t say that the patient is hysterical or anxiety when you have not found a positive sign. Or a disease you haven't discovered is waiting for you in the distance.