Fenestration thread for the treatment of severe perianal suppurative hidrosadenitis and 1 cases of multiple intramuscular fistula

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Zhongshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine Chen JinquanHidradenitis suppurati

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Zhongshan Hospital of Traditional Chinese Medicine affiliated to Guangzhou University of Chinese Medicine Chen Jinquan

Hidradenitis suppurativa is range from large sweat gland infection resulting in skin and subcutaneous tissue wide inflammatory skin disease, often associated with recurrent abscess, sinus fistula, and complexity, extensive infiltration. The location of the disease is located in the sweat gland distribution area, such as the armpit, anus, buttocks, waist, back, groin, and even the head and neck, etc.. Occurs around the anus called perianal suppurative hidrosadenitis. At the end of the Chinese medicine will be broken after breaking called carbuncle, called fistula, cellular leakage, leakage and so on. This disease in 20 - 45 years old young people see more, obese hyperhidrosis tend to suffer from the disease. In recent years, we fenestration drainage method to cure patients with severe suppurative hidrosadenitis patients, is illustrated as follows:

The sick Li Shi x, male, 45 years old. People from Hunan province. First visit in September 13, 2001. Complained of perianal swelling 20 years repeatedly, aggravated in 3 months. In the treatment of anal fistula surgery had no effect in the local. The long-term perianal swelling, oozing pus, not sitting, swelling and pain have recently increased, aversion to cold fever, and made a special trip from Hunan to our hospital. Check: perianal skin tags bulge, surrounding skin swelling dishes, right and 6~11 point range of about 6 * 10cm and 2~6 left point, the lesion of 5 * 8cm, 11 bit swelling range from left scrotum root. Around the anus and the pathological changes of the tissue touch hard, 3, outside the anus, 6, 7, 9 points have 5 small mouth. The back to the back of the waist has dense old scar. Refers to anal hard skin, tenderness. The pressure of the white secretion overflow, smell strange smell. 3, 5, 7, 9, and 11 point mixed hemorrhoids. Laboratory examination of white blood cell 13000u/L, chest X-ray (1) focus of pus culture did not find pathogenic bacteria.

Diagnosis: (1) perianal apocrine gland abscess (2) complex anal fistula (3) mixed hemorrhoids

Methods: 1 surgical lithotomy position to saddle anesthesia after routine disinfection of perianal spread towels, anus 1% Bromogeramine disinfectant, with electric knife in 3 and 9 when a foreign 4cm department for about 2cm prismatic incision deep fascia, bilateral deep fascia see abscess; fascia between layer and layer of skin tissue was gummatous full-thickness necrosis and liquefaction, connected with each other. Detection of the left side of the pus cavity 2 to 6 points, the area of about 4 x 8cm size. The right side of the pus cavity spread 6 ~ 11 hours, an area of about 6 x 10cm size. Fenestration drainage treatment, a total of 7 windows. Insert the curette, thoroughly curettage cavity tissue necrosis pus, clear a lot of fat necrosis tissue. 3, 6, 9 points along the abscess cavity to the anus fistula and see there is a corresponding anal sinus is 8 ~ 10 points when a curved interchange 2cm from anus fistula. 6 full thickness incision fistula, depth of about 2cm, see the thick wall and surrounding tissue, sampling inspection (report for perianal abscess with apocrine change). There is a branch by 4 points and the pus cavity connected exploration left, on the right side there are 2 branches and 7, 8 were connected to the abscess cavity. Complete curettage of necrotic tissue after the fistula fistula with seton treatment (3 in total); the window of abscess cavity with loose seton drainage (8 in total). Milligan Morgan 3, 5, 7, 9 mixed hemorrhoids. After operation, the pus cavity in hydrogen peroxide and repeated washing with normal saline, there were no obvious bleeding in petrolatum gauze hemostatic.

2 after the treatment of conventional intravenous gentamicin and metronidazole for 1 weeks, oral administration of heat clearing and dampness, the traditional Chinese medicine. Strengthen the support therapy; every day with rivanol solution and pus cavity lavage with the solution gauze drainage, 8 ~ 12 days time to remove all the drainage glue line from 12 to 20 days, anal fistula Seton drop pus cavity change Shengji ointment Jiuhua gauze until healing.

3 results in hospital for 22 days. 2 weeks after the review of perianal skin smooth, scar small, anal no obvious defects, no incontinence, stool normal. No recurrence was followed up for 3 years.

 

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