Whether an abscess has formed can be judged by whether there is a fluctuating sensation or whether a fluid dark area is detected during ultrasound examination. Before an abscess forms, antibiotics can be used to fight infection, and anti-infective ointments can be applied topically.

Once a perianal abscess forms, it should be incised and drained as soon as possible. Superficial abscesses such as perianal subcutaneous abscesses can be treated under local anesthesia, while deep abscesses need to be treated under spinal anesthesia or even general anesthesia. Finish. For patients with diabetes, inflammatory bowel disease and other triggers, the original disease should be actively treated while incision and drainage.

Drug treatment

Oral antibiotics

For patients whose infection is not well controlled after abscess drainage, when actively searching for residual abscess, bacterial culture results should be used Adjust antibiotics.

In principle, routine antibiotic treatment is not recommended for uncomplicated perianal abscesses in good physical condition after abscess incision and drainage.

For patients with perineal necrotizing fasciitis, efficient and broad-spectrum antibiotics must be combined with active surgical debridement.

Topical anti-infective ointment

It is mainly used when the abscess has not formed or has not been incised and drained. However, after the abscess is incised and drained, there is no need to continue to use it.

Laxatives

For patients who have difficulty defecating, laxatives can be taken orally to soften the stool and reduce the pain during defecation.

Surgical treatment

Once a perianal abscess is diagnosed, abscess incision and drainage should be performed as soon as possible to avoid further spread of infection. Depending on the depth and location of the abscess, the anesthesia methods and surgical procedures used vary.

Surgical methods

Perianal abscesses in different parts

Superficial perianal abscesses such as perianal subcutaneous abscesses and some superficial ischiorectal fossa abscesses can be treated It is completed under local anesthesia. After the incision, the abscess cavity can be filled with Vaseline gauze to assist drainage and stop bleeding in the abscess cavity. Deep abscesses need to be treated under spinal anesthesia or general anesthesia, and drainage tubes are usually placed to assist drainage.

For rectal submucosal abscesses, intersphincteric abscesses, and supralevator ani abscesses formed by intersphincteric spread, abscess incision and drainage or internal sphincter incision drainage are required under anoscope.

When an ischiorectal fossa abscess merges with a supralevator ani space abscess, drainage should still be through the ischiorectal fossa, and the levator ani muscle must be fully expanded and a drainage tube must be placed. The skin opening for an abscess should be large enough to prevent the skin from healing before the abscess.

Perianal abscess complicated by anal fistula

Because some patients with perianal abscess are complicated by anal fistula, for these patients, it is still unclear whether anal fistula incision or seton surgery should be performed at the same time during abscess incision and drainage. There is some controversy. Accurately finding the sinus tract and internal opening to avoid creating false sinus tracts is the key to success. It is recommended that concurrent surgery be performed only in hospitals with sufficient experience. For complex anal fistulas, surgery should be performed again after the perianal abscess has healed to reduce surgical complications.

Perianal abscess combined with perineal necrotizing fasciitis

For patients with perineal necrotizing fasciitis, the skin should be fully incised and the necrotic skin and subcutaneous tendons should be removed Apply membrane to fresh and bleeding wounds, and use high-efficiency broad-spectrum antibiotics at the same time. The wound should be checked promptly after surgery. If there is new necrotic tissue, it can be debrided again every 2 to 3 days. Severe cases often require multiple debridements to recover. Necrotizing fasciitis has a high mortality rate, so debridement should be as thorough as possible without concern for reconstruction of skin and soft tissue defects. When the infection is close to the anus, a colostomy should be performed to avoid fecal contamination of the wound.

Postoperative care

Diet

The diet should be light and soft, and spicy food should be avoided.

Drugs

You can take bulk laxatives to soften the stool and reduce the pain caused by defecation.

Warm water sitz bath

After incision and drainage of superficial perianal abscesses, you can use 1:5000 concentration of potassium permanganate warm water (boil first and then cool) or warm water with iodine. Take a sitz bath and immerse the anus in warm water for 10 to 15 minutes, 2 to 3 times a day.

Abscess cavity flushing

After incision, deep abscesses can be flushed with normal saline under the guidance of a doctor. If the abscess cavity is very deep, you can also use gauze to pack and drain it loosely to prevent the incision skin from healing before the abscess cavity.

Traditional Chinese medicine treatment

Before abscess formation, traditional Chinese medicine ointment with anti-infective effect can be used for external application.