Ischiorectal abscess

　　Overeating spicy, fatty, and strong wine, which damages the spleen and stomach, leads to endogenous damp-heat. Prolonged damp-heat can transform into heat, causing flesh to rot and develop into carbuncles or lung and kidney Yin deficiency. Damp-heat phlegm and turbidity accumulate around the anus, causing prolonged heat and flesh rot, leading to this disease. Acute suppurative infection occurs in the soft tissue around the anal canal and rectum or in the surrounding spaces. Common pathogenic bacteria include Escherichia coli, Staphylococcus aureus, Streptococcus, and Pseudomonas aeruginosa. Occasionally, anaerobic bacteria and tuberculosis bacteria may be involved, often in mixed infections. Sacrorectal abscess is relatively common, often caused by infection of the anal glands spreading outward through the external anal sphincter to the sacrorectal space.

　　If not treated promptly, the abscess often penetrates downward into the perianal space around the anal canal, and then exits through the skin, forming a high anal fistula. A high anal fistula is relative to a low anal fistula. A high anal fistula refers to one located above the anal rectal ring plane, while a low anal fistula is located below. Generally, the cause of anal fistula formation is due to the rupture or incision of rectal abscess, resulting in thick pus. It is a common anal disease that, if left untreated for a long time, can greatly affect the patient's life, work, and study.

　　Sacrorectal abscess is relatively common, often caused by infection of the anal glands spreading outward through the external anal sphincter to the sacrorectal space. The abscess is deeper and wider than the perianal abscess, with a volume of about 60-90ml. During the onset, there is a persistent pain on the affected side, which gradually worsens, causing discomfort while sitting or standing. There may also be systemic infection symptoms such as fatigue, fever, loss of appetite, and even chills and nausea. Sometimes, there may be reflexive difficulty in urination. Due to the deep location of the infection, local signs are not obvious at the initial stage. Later, there may be redness and swelling on the affected side, sometimes with deep tenderness. Rectal examination may reveal a tender mass on the affected side, even with fluctuation. If not treated promptly, the abscess may penetrate downward into the perianal space around the anal canal, and then exit through the skin, forming a high anal fistula.

　　1. Avoid eating spicy, fatty, and fried foods. Eat more light and vitamin-rich foods, such as fresh vegetables like mung beans, radishes, and winter melons, as well as fruits. In terms of diet, eat more protein-rich foods like lean meat, beef, and mushrooms.

　　2. Actively treat related lesions, such as anal sinusitis, proctitis, etc.

　　3. Treat the disease as soon as possible after diagnosis to prevent the expansion of the lesion range.

　　1. Blood routine

　　The total white blood cell count in the blood routine is above 10X10^9, with neutrophils greater than 70%. The abscess range is deeper and wider than that of perianal abscess, with a volume of about 60-90ml. During the onset, there is persistent pain on the affected side, which gradually worsens, causing restlessness when sitting or standing, and may also have systemic infection symptoms such as fatigue, fever, loss of appetite, and even chills, nausea, etc.

　　2. Rectal examination

　　There may be reflexive difficulty in urination. Due to the deep location of the infection, local signs are not obvious in the early stage, and later local redness and swelling may occur on the affected side, sometimes with deep tenderness. Rectal examination shows a tender mass on the affected side, and even fluctuation.

　　The diet for ischiorectal abscess patients should include more high-fiber foods, which mainly come from natural vegetables, fruits, grains, and beans. Cruciferous vegetables in vegetables contain abundant antioxidant vitamin C and carotene, which can inhibit the synthesis of carcinogenic substances such as nitrosamines. These vegetables include broccoli, kale, cabbage, etc. Most yellow and green fruits and vegetables contain abundant flavonoids, and other foods such as onions and apple skins also contain flavonoids that can be eaten more.

　　Perirectal abscess is easy to spread and should be surgically treated early. Generally, sacral anesthesia is used, and the patient is placed in a lateral or lithotomy position. A large-bore needle is first used to puncture the area of marked tenderness, and pus is aspirated. An incision is then made in the anterior-posterior direction at this location. Generally, the incision should be more than 2.5 cm away from the anus to avoid injury to the anal sphincter muscle. After incising the abscess cavity, insert the index finger to separate the fibrous septa within the abscess cavity, drain the pus, and then excise a small amount of marginal skin and subcutaneous tissue to facilitate drainage. Gauze soaked in Vaseline is used for drainage. When incising and draining, pay attention to the amount of pus drained; if it exceeds 90ml, it often indicates that the abscess may have involved the contralateral ischiorectal fossa or has involved the pelvic-rectal space above the levator ani muscle. A careful exploration is required.