(Disclaimer: This article is only for popular science purposes, in order to protect patient privacy, the relevant information in the following has been processed)
For modern people, there is nothing that cannot wait, especially the two things of "pulling" and "sprinkling" are delayed again and again. For example, busy taxi drivers, office workers, medical workers, such people in the busy work, often do not have time to solve the problem of three emergencies, can only hold hard, and this hold, it is easy to have problems.
Last month, I received a patient who couldn't go to the toilet for a long time due to his busy schedule, and over time, hemorrhoids.
First acquaintance with the patient
The patient used to be a taxi driver, leaving early and returning late, running on the road all day, due to the special industry, so when encountering three emergencies, he could only hold back. In order to avoid frequent toilet visits, patients rarely drink water or eat at work. Over time, the patient's frequency of bowel movements is significantly lower than that of normal people. Originally the defecation habits are not good, coupled with long-term sedentary, hemorrhoids also came as promised, looking for the door.
Found to have hemorrhoids, the patient did not care too much, because in the driver group, the incidence of hemorrhoids is relatively high. So he consulted with other colleagues and asked about treatments for hemorrhoids. At the recommendation of a colleague, he has been treated with a certain hemorrhoid cream. Time passed quickly, twenty years passed in the blink of an eye, I thought that the hemorrhoid cream could manage for a lifetime, but a week ago the patient's blood in the stool symptoms worsened, so he came to the hospital for treatment.
After listening to the patient's description, I was very sad that I could delay 20 years to come to the hospital for treatment, which is also rare in clinical practice. Because the patient's hemorrhoid history and symptoms are more obvious, so I conducted a digital rectal examination, and the results suggested that the patient could see an margin lump at 6 points of the knee chest position, about 3 * 1.5 cm, the base was located on the tooth line, the tenderness was obvious, the finger sleeve was not stained with blood, in line with the mixed hemorrhoid performance, so the outpatient clinic was admitted to the hospital with mixed hemorrhoids.
The course of treatment of the patient
Because the patient's symptoms are more typical and the medical history is long, after admission, the patient is arranged to improve the relevant tests, such as blood routine, biochemistry, tumor markers, CT, etc. Among them, the blood routine suggests: white blood cells 4.25 * 10 ^ 9 / L, neutrophils 2.70 * 10 ^ 9 / L, erythrocytes 4.44 * 10 ^ 12 / L, no obvious abnormalities. Tumor marker examination suggests: glycoside antigen 199 (CA199) 6.30U/mL, glycoantigen 125 (CA125) 12.00U/mL, in the normal range. However, CT suggests: 1. Multiple small nodules in both lungs, some of which are ground glass-like changes; 2, inflammation of the lower lobe of the left lung; 3, a small amount of pericardial effusion. 4. C3/4, C4/5, C5/6 intervertebral disc herniation, degenerative changes in cervical spine.
Combined with the patient's symptoms, signs, laboratory tests, and imaging reports, the diagnosis is definitively mixed hemorrhoids, sinusitis, pneumonia, pericardial effusion, and cervical spondylosis. So the department organized a multidisciplinary consultation, and after many discussions, it was decided to solve the problem of mixed hemorrhoids of patients first, and to solve the patient's primary disease before going to other departments.
After fully discussing the treatment plan with the patient, the patient expressed understanding and cooperation with the treatment, so after improving the preoperative routine examination and clarifying that there were no surgical contraindications, hemorrhoidal external exfoliation under local anesthesia. After exposing the surgical area, the mid-curved forceps are clamped along the bottom of the 6-point hemorrhoid base after longitudinal clamping, and the knife is used to cut the edge along the lower side of the forceps, so that it reaches the root of the hemorrhoid on the tooth line, and then ligation and excision. After the successful completion of the operation, the patient returned to the ward safely and continued to be treated with anti-infection, symptomatic and hemostatic treatment.
Precautions for patients in treatment
- Make preoperative preparations, fast, water, and empty the bladder as instructed by the doctor.
- After the operation, the diet should be light, eat more fresh vegetables and fruits, especially crude fiber foods, such as grains, cucumbers, etc., to keep the stool unobstructed, avoid spicy and irritating, fat and sweet foods.
- It is not advisable to defecate on the day after surgery, and the first defecation time is appropriate to 1 to 2 days after surgery, and at the same time, pay attention not to defecate too hard, take deep breaths during defecation, reduce abdominal pressure, promote gastrointestinal peristalsis, and help the stool to drain.
- Closely observe the condition, if there is abnormal bleeding, granulation edema, false healing, stenosis, etc., timely inform the doctor.
Therapeutic effect of the patient
After returning to the ward, the patient's general condition is ok, the vital signs are stable, and the pathological results of histopathology for examination and resection suggest that they are in line with the general and microscopic manifestations of the hemorrhoidal nucleus, and the diagnosis is confirmed. After a period of anti-infection, symptomatic and hemostatic treatment, the patient recovered well, the wound was not red and swollen, the tissue was fresh, the drainage was smooth, and there was no obvious purulent discharge, so the discharge was successfully arranged.
When discharged from the hospital, cefixime was given oral and fusidic acid cream anti-infective treatment, and instructed to return to the hospital to change the dressing at regular intervals until the incision was healed.
Precautions for patients in their daily lives
1. Develop a good habit of regular defecation, do not tolerate the awareness of defecation, and reduce the congestion symptoms of the anorectal part.
2. The combination of work and leisure, overwork, weight bearing or squatting for a long time, sitting for a long time, etc. can make the veins of the anorectum accumulate and affect the bowel movement.
3. Pay attention to personal hygiene: keep the anus clean and clean, wear comfortable, loose underwear, and avoid hurting the skin around the anus due to excessive tightening.
4, the diet should be light, eat more fresh vegetables and fruits, especially coarse fiber food, such as grains, cucumbers, etc., in order to keep the stool unobstructed, avoid spicy and stimulating, fat and sweet foods.
5. Return to the hospital regularly to change the medicine, review, inform the doctor in time if there is discomfort, and deal with it as soon as possible.
Doctors feel good
Many patients and this time to come to the same patient, think that hemorrhoids is a small disease, do not need to pay too much attention, after using hemorrhoid cream symptoms to improve, they are troublesome, do not want to go to the hospital for treatment. However, this kind of thinking and behavior is very dangerous, and if mixed hemorrhoids are not effectively treated for a long time, the condition will continue to worsen. For example, at the beginning, there is only occasional blood in the stool, and then it will develop into dripping blood, jet-like bleeding, and even develop into a cough or heavy work will come out, and finally there will be incarcerated necrosis, which poses a serious threat to the patient's life.
The patient delayed again and again until 20 years later, when the hemorrhoids came out and the symptoms of blood in the stool were significantly worsened, and then came to the hospital for treatment. At this time, the patient's hemorrhoid symptoms have been more serious, and there are cervical spondylosis, pneumonia and other diseases, which increases the difficulty of treatment. Therefore, the department organized a multidisciplinary consultation at the first time, prioritized and graded the patient's situation, and finally decided to first mixed hemorrhoidal exfoliation and internal zlurgy to deal with the patient's blood in the stool.
In the process of communicating with the patient before surgery, the patient said that he was afraid of the operation, did not know whether he could eat normally, worried about eating too much, the number of bowel movements was too much, and the feces would affect wound healing. However, if the patient over-controls the diet, it will cause the feces to stay in the intestine for too long and dry knots to cause constipation, affecting the treatment effect. Therefore, in order to prevent constipation, I recommend that patients fast from spicy and irritating foods and unclean foods after surgery, and eat more leafy vegetables, fruits, and honey. During the shedding period of hemorrhoids, prophylactic laxatives such as liquid paraffin wax are taken prophylactically to keep the stool unobstructed. Through dietary guidance, the patient's bowel movements are acceptable, and the postoperative recovery is also better.
Takamori
Hefei Second People's Hospital
General Surgery Attending Physician
[This article was first published in "Dr. Xiaohe", published by the doctor with the authorization of the doctor, the copyright belongs to the doctor personally, it is forbidden for anyone to reprint plagiarism, and violators will be investigated】