337. New ways to deal with ulcers

Author: Hao Xifeng

337. New ways to deal with ulcers

Perianal abscess has always been a common disease, and the cause is nothing more than spontaneous anal crypt infection and secondary infection caused by various other diseases. [1]

If you sit for a long time and do not pay attention to protecting the pg, an important weight-bearing part that often bears most of the body's weight, affecting the surrounding blood supply and skin health, or causing anal canal rupture and bleeding, the chance of infection will become very high.

Considering the physical quality and living habits of people around the world in the 19th century, it is not surprising at all that perianal abscesses occur. Even those aristocratic friends who have been riding horses and marching for a long time can become an important part of this disease.

Faced with such a large base of disease sources, there are not many corresponding treatment measures. The main reason is the lack of anti-infection and basic disease means.

Only when the abscess cavity is ulcerated and a fistula is produced will surgery be performed to treat it.

For surgical treatment after the formation of anal fistula, the method is actually similar, which is to incise the fistula tract. Whether it is to deal with the low-level anal fistula directly and roughly with a knife or scissors, or to use a seton to deal with the high-level anal fistula, the ultimate goal is to incise the fistula tract, and at the same time

Ensure drainage and incision healing.

However, in France, the treatment of anal fistula still has a unique historical significance.

"The great Sun King of the time was witty, confident and brave. He loved riding horses and hunting, and made Europe surrender to his feet. At the same time, he was also the record holder of 2,000 recorded enema flushes, but this move made him

On January 15, 1686, he suffered from a very severe perianal swelling."

The public surgery on the 19th was opened by Professor Serdieu. The content was more like an introduction before the start of the arena, which gave Carvey a sense of immediacy as he was about to cut open the PG on Louis XIV:

"On February 18, the swelling began to spread, liquefy, and was confirmed to be a severe buttock abscess. After fighting the abscess for nearly three months, the Sun King's buttock skin finally couldn't bear it on the night of May 2.

The huge pressure in the abscess cavity causes it to rupture and release a large amount of pus.

The pressure disappeared, the fever subsided, and the pain stopped, but the abscess cavity left a persistent fistula, which is an anal fistula. What follows is the legendary story of the doctor named Charles-François Félix de Taci.

.He cured the Sun King and even developed fistulotomy into a fashion among the nobles.

At that time, more than 30 courtiers were willing to undergo similar surgeries, and were willing to wrap the same style of bandages around their chest and waist as the Sun King. But it was a pity that Dr. Detaci could not pick up the sickle-shaped scalpel again.

And he retired early and went back to the countryside to retire."

Kawei had never seen such an opening that was linked to a historical figure. From his words, he could hear that Sedieu's attitude was completely different from the previous discussion.

"Now this patient has encountered the same dilemma, but because of the rapid development of medical treatment, he no longer needs to wait for more than two months like the Sun King."

Sedieu finally gave the right to speak to Kawei: "Next, it will be Kawei, a genius surgeon in Vienna, who will recreate the superb skills of Dr. Detaci."

"Thank you Professor Cediyo for such a detailed preoperative introduction."

Kawei put his hands in front of him, put on clean gloves, and then said: "My historical level is quite bad. I don't know the situation of the Sun King's abscess. But one thing I am sure of is that the abscess of this farmer friend has been cured."

Very serious.

As you can see, the red and swollen area spreads from the buttocks down to the left lower limb, until the back of the knee, which is above the popliteal fossa. If you want to solve the abscess, you must completely incision and drainage to remove all the pus hidden in the body.

."

The surgical method is very simple, but the scale is much larger than a normal abscess incision and there are many more incisions, which is not in line with the clean and neat style of the 19th century.

The doctor present did not know much about cesarean section and was unable to open the mouth during previous operations, but he had extensive experience in treating perianal abscesses and anal fistulas.

They didn't understand Kawei's practice of incision in case of emergency: "If you want to make a full incision? The incision is too big. Once such a large incision is made, ulcers will appear after the operation. Oh no! There will definitely be ulcers.

Such a large-scale ulcer is more terrifying than an abscess!"

Kawei defended: "So I chose to increase the number of incisions and limit the size to about 5cm."

"Small incisions are not too small. Even ordinary post-war wounds have more than half a chance of dying from ulceration."

"It's really too bold to do all the incisions."

"It is better to try conservative treatment. Only perform incision and drainage on the buttocks. The thighs can be temporarily released. If there is more serious swelling in the future, it is not too late to choose incision."

Kawei listened to their various suggestions and stood aside shaking his head: "For this kind of patient, all abscess cavities must be eliminated at once, otherwise the incision will never grow properly. Over time, the incision will still ulcerate, don't say anything in the end

If you save your left leg, you may still have to follow the old path of ulceration and death."

"That's true, but isn't it the normal state of this disease?"

"Yeah, it's normal for an abscess to be so serious that it causes ulcers."

"Dr. Kawei, medicine cannot be over-the-top. It is the disease that causes the death of the patient, not the doctor. Before treatment, you must calm down and not be too impatient. If it still ends in death, it is not because of our poor medical skills, but because of abscess.

It’s too violent in itself, but we tried our best.”

Preaching is good and a good placebo, but it only applies to the current medical environment and does not apply to Kawei.

"I'm here to demonstrate the surgery, not to quarrel with you. I have no such obligation and no such interest. I have my own attempt, and the patient also signed the consent form for the surgery and is willing to bear all the consequences."

After showing a written agreement using money as a bargaining chip, Carvey continued: "If surgery wants to develop, it will inevitably incur huge costs. It is inevitable on the road of development, and it cannot be avoided with conservative treatment.

What we have to do is not to carefully avoid this kind of cost, especially when the existence of the cost has little to do with the final result, it is even more important for someone to stand up."

The approach is very cold-blooded. From another perspective, it means treating patients as surgical experimental materials. However, Kawei's treatment methods have also passed the test of the times. If it were the surgeons in front of him, random innovation would definitely not be advisable.

"Because it is a brand-new surgical method, the results are unknown, and it will cause some unpredictable risks to the patient."

Kavey motioned to Armor to perform anesthesia, and then he counted the surgical instruments again: "So I gave a compensation suggestion of 3,000 francs. That is, if the operation failed and caused my death, I am personally willing to pay 3,000 francs. I personally suggest that if you have

This innovative idea should also come with a compensation mechanism."

This sentence can be regarded as blocking the mouths of a small group of people who want to kidnap morals, but it is difficult for Sediyo on the side to understand.

With a smile on his face, he lowered his voice and whispered to Kavi: "You are so rich. You spent more than 2,000 francs on the sponge and it was not enough. You even came up with such a compensation agreement."

Kawei also smiled: "The sponge should be paid for by the Main Palace Hospital."

".There is no reward for successful treatment?"

"Does it count to create a new treatment plan?" Kawei asked rhetorically, and then comforted, "The professor earns nearly 20,000 francs per month, which is nothing. Moreover, as long as the preparations are made, and after sufficient preparation,

Animal experiments should be able to achieve the minimum safety."

The two began to wait for the final round of disinfection, which covered the patient's entire lower body and lower back, and the number of instruments required was far beyond the imagination of other doctors.

Two buckets of gauze and five jars were exciting enough. Unexpectedly, there was also a large bundle of rubber tubes and several syringes. Of course, there was also the standard solution for Kawei surgery - water, with an appropriate amount of salt added.

.

"This surgery will be very extensive, so carbolic acid will be used as the main disinfectant." Kawei pointed to his mask and said, "Considering the toxicity of carbolic acid, I hope everyone will wear a mask as much as possible."

Originally, a lot of alcohol was sprayed on the surgical area, and now a large amount of carbolic acid was added to it, making the smell extremely choking.

"Cough cough cough~~~Cough cough~~~I feel so choked."

"If Mr. Bizet feels uncomfortable in his throat, you can choose to go to the top floor or leave here directly." Kawe specially asked Bizet to come in to find inspiration. He also hoped that he could see the development of medicine and come to the hospital for examination as soon as possible. "After all,

This is the surgical area."

"It doesn't matter, I can bear it"

"Although I want to tell you that it may not be possible, because the next step is the highlight, but... forget it." Kawei glanced at him, "Don't forget the agreement between us."

"Don't worry, don't worry, ahem, as long as I finish writing this article, I will go to your place for a checkup. Ahem, cough~~~"

Kawei’s words are not alarmist. The smell of pus in abscesses like this is not very good. Ordinary people have not received "practice" in this area and are easily affected by the dual impact of vision and smell, causing nausea and vomiting.

and other phenomena.

But to the surgeons in the theater, the stench was comparable to the stench of a decomposing corpse.

"We will expand the wound from the ulcer 2cm away from the anal verge." Kawei simply cut it gently with a scalpel, and then quickly shouted, "Aspirator."

Just a hole was made in the fat layer, and a large amount of dark red liquid hidden inside rushed out with a very strong smell of feces. Even if Berget and Damirgaon were standing by, even if Kavi had already

The reminder was very timely, but there was still no way to completely stop the pus from flowing out.

Suddenly, the entire surgical area was filled with a foul odor, which quickly spread to the surrounding area.

Bizet, who just now said he could hold back the pungent smell, was like a deer frightened by the hunter's gunfire. He retched in his upper abdomen. He quickly covered his mouth and nose with his sleeve, picked up his manuscript and pen with his other hand, and quickly

He ran to the top of the auditorium.

He did not sit down in a hurry, but chose to open the window closest to him and sucked in the fresh air outside the window.

The pus was thicker than they thought, and the suction of the manual suction device was not smooth. Regardless of whether it was Kawei who controlled the position of the nozzle, he finally got through it after stumbling.

After the pus hidden between the superficial muscles left, the dark red slowly turned into flesh red, the smell became more pungent, and the hiding place became more hidden: "It's almost bottomed out."

"Remove the suction device and give me gauze." Kawei put the fingers of his left hand into the incision to explore, and took the gauze forceps given by Karen with the other hand. "There is still some pus remaining in the muscle gap of the thigh. The same is true for the perianal muscles.

Fortunately, the abscess cavity did not spread upward, otherwise it would slowly seep into the abdominal cavity or even the retroperitoneum. Get some water."

Originally, all areas needed to be thoroughly explored before flushing, but now the entire incision was contaminated with pus. Kawei did not have qualified antibiotics, so repeated flushing and disinfection were needed to ensure that the surrounding tissue was as clean as possible.

Everything is a helpless move due to the lack of antibiotics.

"There's not enough water, go get some more."

Kawei continued to explore the scope of the abscess cavity in the buttocks: "The abscess cavity penetrated the levator ani muscle from the side, and produced a finger-sized ulcer on the rectal wall about 7cm away from the anal verge. Although it did not directly enter the abdominal cavity, it invaded the abdominal cavity.

The range is wider than we imagined, reaching inward near the tip of the coccyx and outward to the ischial tuberosity."

This was the most exaggerated perianal abscess Kawei had ever seen. The pus was thick and thick and covered the entire buttocks. A 5cm incision alone could not achieve the drainage effect at all.

"Hold on for the lower limbs, let's deal with the necrotic tissue around the buttocks first." Kawei took a pair of scissors and tweezers, "Herman, cut a piece of sponge, 7*5cm in size, and then use the front ends of two rubber tubes to make a few small holes.
To be continued...