Lohsiriwat Varut
Varut Lohsiriwat, Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
World J Gastroenterol. 2016 Jul 14;22(26):5867-78. doi: 10.3748/wjg.v22.i26.5867.
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer. Sexually transmitted diseases as anorectal non-surgical emergencies and some anorectal emergencies in neonates are also discussed. The last part of this review dedicates to the management of early complications following common anorectal procedures that may present as an emergency including acute urinary retention, bleeding, fecal impaction and anorectal sepsis. Although many of anorectal disorders presenting in an emergency setting are not life-threatening and may be successfully treated in an outpatient clinic, an accurate diagnosis and proper management remains a challenging problem for clinicians. A detailed history taking and a careful physical examination, including digital rectal examination and anoscopy, is essential for correct diagnosis and plan of treatment. In some cases, some imaging examinations, such as endoanal ultrasonography and computerized tomography scan of whole abdomen, are required. If in doubt, the attending physicians should not hesitate to consult an expert e.g., colorectal surgeon about the diagnosis, proper management and appropriate follow-up.
肛肠急症是指伴有急性肛门疼痛和出血等警示症状的肛肠疾病，可能需要立即处理。本文探讨常见肛肠急症的诊断和处理，如急性血栓性外痔、血栓形成或绞窄性内痔、出血性痔、肛门直肠静脉曲张出血、肛裂、不可回纳或绞窄性直肠脱垂、肛周脓肿、会阴坏死性筋膜炎（福尼埃坏疽）、滞留的肛门直肠异物和梗阻性直肠癌。还讨论了作为肛肠非手术急症的性传播疾病以及新生儿的一些肛肠急症。本文综述的最后一部分致力于常见肛肠手术后可能作为急症出现的早期并发症的处理，包括急性尿潴留、出血、粪便嵌塞和肛肠败血症。尽管许多在急症情况下出现的肛肠疾病不会危及生命，且可能在门诊成功治疗，但准确诊断和妥善处理对临床医生来说仍是一个具有挑战性的问题。详细的病史采集和仔细的体格检查，包括直肠指检和肛门镜检查，对于正确诊断和治疗方案至关重要。在某些情况下，需要一些影像学检查，如肛管超声检查和全腹计算机断层扫描。如有疑问，主治医生应毫不犹豫地就诊断、妥善处理和适当的随访咨询专家，如结直肠外科医生。
