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Journal of the Korean Academy of Family Medicine 1991;12(6):38-45.
Published online June 1, 1991.
A clinical study of the inpatients with anorectal diseases.
Jong Min Won, Jae Ha Choi, Jeong Dong Han, Hye Won Kim
항문직장질환으로 입원한 환자에 대한 임상적 고찰
원종민, 최재화, 한정동, 김혜원
강서병원 가정의학과
Abstract
Family physicians must understand well about the common anorectal diseases. And can do definitive care by doing not only diagnosis and conservative care but also anesthesia and operation.
We concluded as follows by clinical study of the 233 patients who had been admitted to the Dept. of general surgery Gang soo hospital for surgical treatment of hemorrhoid. anorectal abscess. anal fistula or anal fissure from January 1989 to June 1990.
1. The frequency of the diseases was as follows : hemorrhoid (140 cases. 55.8%), anorectal abscess (43 cases, 18.4%), anal fistula (40 cases, 17.2%) and anal fissure (20 cases, 8.6%) in the decreasing order.
2. The age distribution indicated a predominant incidenhce in 3rd to 5th decade (20-49 years : 85.0%) and male to female ratio was 2.6:1
3. The main clinical symptoms of hemorrhoid were protruding mass (97.7%), pain (74.9%) and bleeding (58.5%). The pain (100%) was chief complaint of the anorectal abscess. The discharge (100%) in the anal fistula and the pain (100%) with bleeding (95.0%) in the anal fissure were chief complaints respectively.
4. The duration of hospitalization was 6 to 10 days in 129 cases (54.4%)
5. The most frequent clinical type was external hemorrhoid (47.7%) in the hemorrhoid, perianal type (58.1%) in the anorectal abscess, and intersphincteric type (82.5%) in the anal fistula respectively.
6. Examining the anatomical location, the most frequent direction of the hemorrhoid was 7 o'clock (63.1%) and followed by 4 o'clock (55.4%) and 11 o'clock (51.5%). The majority of anorectal abscess was situated posterior part (55.8%) and the majority of external opening or internal opening in anal fistula was also situated posterior part (44.9%, 53.8%). The most frequent direction of the anal fissure was 6 o'clock(70.0%).
7. The caudal block was chosen preferentially in the operation and other techniques were used in case of anesthesia failure or unavoidable occasion. The 132 cases (85.2%) were anesthetized by caudal block, and the 17 cases (11.0%) were anesthetized by spinal anesthesia. Among the 17 cases of spinal anesthesia, the 11 cases were anesthetized by spinal anesthesia due to failure of caudal block. So, the successful rate of caudal block was 92.3%.
In conclusion, the clinical manifestations of the anorectal diseases revealed no significant differences compare with other studies, but we came to have knowledge that the caudal block was one of the safe, simple and successful anesthetic techniques. We recommend that the family physicians actually take part in the definitve care of anorectal diseases.


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