External anal injuries

　　External anal injuries are caused by the following three reasons:

　　1. Stab wounds to the anal area:As hard objects such as metal, wood shavings, bamboo tips, etc., when falling from a height and landing on the buttocks, they can stab the anal and soft tissue of the buttocks. Most of these injuries are accidental, but during the Vietnam War against the United States, the Vietnamese people set up bamboo tip stakes, often causing American soldiers to fall into traps and be injured; in rural areas, injuries from horned cattle are common. When a fierce water buffalo becomes angry, if it encounters a person running away, the fierce bull will chase from behind, using its horn to strike the buttocks, commonly resulting in stab wounds to the anal and soft tissue of the buttocks, and sometimes tearing the anus.

　　2. Gunshot injuries during war: bullets hitting the anal area:In the proportion of battlefield injuries, the incidence is very low. In the Chinese People's Liberation Army's counter-attack on Vietnam (1979), rectal and anal injuries accounted for only 3.64%.

　　3. Bruise and laceration injury:Common in patients with mental abnormalities or sexual deviation, causing injury by inserting foreign objects into the anal and rectum; it can also occur in iatrogenic cases, such as when the patient is afraid of contracting the anal sphincter due to fear during the rectal and sigmoid colonoscopy examination, and the examiner uses rough force; in addition, forgetting to remove the thermometer when measuring the anal temperature may cause the thermometer to break and cut the anal opening. Such injuries are usually mild; in the case of anal surgery, such as incorrect anal fistula surgery, leading to anal incontinence, it is more serious.

　　In addition to its clinical manifestations, perianal injuries can also cause other diseases. This disease is prone to cause deep cellulitis of the gluteus maximus, hematoma rupture and bleeding, which should attract the high attention of clinical doctors and patients.

　　Whether it is battlefield injury or civilian trauma, the history of perianal trauma is the primary method for obtaining a diagnosis.

　　Clinical manifestations: anal pain after injury, bleeding or anal incontinence, stricture leading to difficulty in defecation, thin stools. Early examination after injury can show lacerations of the anal and surrounding tissues, bleeding, and transverse rupture of the anal sphincter. Those with feces leakage and contamination are common. In patients with severe infection for a long time, there may be deep cellulitis of the gluteus maximus.

　　Classification:

　　1. Bruise (hematoma).

　　2. Laceration injury

　　(1) Non-perforated (non-metallic).

　　(2) Perforation (full thickness, but not completely transverse).

　　(3) Large-scale damage (avulsion, complex, rupture, tissue loss).

　　When medical personnel perform rectal and sigmoid colonoscopy, they should inform the patient not to be afraid, otherwise, fear may cause the patient to contract the anal sphincter, leading to perianal injury. The examiner's actions should be as gentle as possible. In addition, when measuring the anal temperature, do not forget to remove the thermometer to avoid breaking and cutting the anal opening.

　　Rectal digital examination:Under strict aseptic conditions, using fingers wearing gloves to perform rectal and anal digital examination, the finger movement should be gentle. Instruct the injured person to contract the anal sphincter to determine if there is a rectal sphincter rupture. If there is a rupture, the anus will lose tension and become relaxed. If only partially torn, the tension of the sphincter can still be felt. Through the finger examination, it is also possible to understand whether the lower rectum is pierced. The judgment can be made from the examiner's feeling. If the intestinal wall is smooth, there is no injury. If there is a perforation, there will be local pain and a sense of emptiness.

　　Dietary taboos for patients with perianal injuries:

　　1. Initially, only a small amount of warm water should be consumed. If there is no special discomfort, solid food can be introduced, such as vegetable soup, fish soup, thin gruel, egg soup, and fruit juice without seeds. The amount of food should start from 20 to 30 milliliters per meal and gradually increase to 200 to 300 milliliters.

　　2. You can switch to low-fiber semi-liquid diet, such as thin porridge, noodle paste, steamed egg custard, various vegetable purees, etc., half a bowl to a bowl each time, 3 or 4 times a day. You can also eat some liquid food between meals.

　　3. Generally, you can transition to soft food 7-10 days after surgery, such as porridge, bread, apples, bananas, oranges, etc., 3 or 4 meals a day. About a month later, you can gradually transition to normal diet.

　　4. Eat more fresh fruits and vegetables to keep the stool formed and soft, which can reduce local irritation.

　　5. Avoid foods with刺激性 odor and flatulence, such as onions, garlic, and sweet potatoes.

　　6. It is best to eat less or not eat foods that are difficult to digest, such as milk, beans, sweet potatoes, etc.

　　7. Avoid spicy and刺激性 food.

　　Therapeutic Recipes for Postoperative Recovery of Physical Qi after Perianal Trauma:

　　1. Take 4 grams of Jilin Shen, 3 grams of American Ginseng, and stew lean meat.

　　2. Stew 4-5 mushrooms with lean meat or chicken breast (drink the soup).

　　3. Take 15 grams of Beiqi, 21 grams of Dangshen, 30 grams of Huai Shan, and 15 grams of Lianzi and stew lean meat.

　　4. Take 30 grams of Tuifuling, 30 grams of raw Yiren, and 3 dates and stew grass carp or water turtle.

　　5. Take 17 grams of Dangshen, 21 grams of Zhishen, 10 grams of Jiazi, and 15 grams of Yiren and stew lean meat or chicken.

　　6. Take 3 grams of Tianqi, 3 grams of Ginseng (or Red Ginseng) and stew lean meat or chicken.

　　Surgical Treatment for Perianal Trauma

　　1. When debriding locally for anal injury, it is important to cherish the tissue, save as much tissue as possible, align it, and suture and repair it to prevent malunion; except for one broken anal sphincter, all should be sutured and not excised. After local debridement, perform a horizontal double-layer suture and place a drain in the sacral prevertebral area around the anal canal.

　　2. To prevent local infection after the repair of the anal and anal canal, a sigmoid colostomy is performed at the proximal end. This allows the repair site to rest fully and heal smoothly. The distal sigmoid colon and rectum should be thoroughly flushed with normal saline, and washed with neomycin and metronidazole solutions.

　　3. Prevent and treat infections preoperatively, intraoperatively, and postoperatively with the third-generation cephalosporins such as先锋必 or 菌必治 and metronidazole, etc., to prevent and treat infections.