Losing weight and having perianal abscess? Changsha Fourth Hospital warns: Be careful of "green cancer"

Recently, 30-year-old Mr. Feng lost weight rapidly, losing 15kg in less than a month, and suffered recurrent perianal abscesses and anal fistulas.

Mr. Feng, who was suffering from the disease, was introduced by an acquaintance to the anorectal surgery clinic of Changsha Fourth Hospital for treatment. After receiving the patient's diagnosis, Gao Yong, deputy chief physician , completed colonoscopy and anal MRI and other related examinations according to the patient's condition, and considered the following: high-position complex anal fistula, perianal abscess, and Crohn's disease.

The gastrointestinal and bariatric surgery department performed a one-time radical resection of perianal abscess + TROPIS surgery for Mr. Feng, which greatly reduced the damage to the anal sphincter. After the surgery, the gastroenterology department gave Mr. Feng regular biological agent treatment, and Mr. Feng's condition was well controlled.

"Thanks to the doctor for helping me find out the cause of the disease. I have undergone many operations before due to perianal abscess and anal fistula." Mr. Feng is very grateful to Changsha Fourth Hospital for solving the problem that has troubled him for a long time.

Crohn's disease is known as the "immortal cancer" and "green cancer". What exactly is this disease? Let's take a look at it:

1. What is Crohn’s disease?

Crohn's disease is a chronic transmural inflammatory bowel disease of unknown etiology that can affect the entire digestive tract, with the terminal ileum, colon, and perianal area being the most common sites.

The main clinical manifestations include abdominal pain and cramps, chronic diarrhea, weight loss, blood in the stool, mucus in the stool, and, for adolescent patients, growth retardation.

In addition, Crohn's disease may also cause extraintestinal manifestations, including joint damage, skin and mucous membrane lesions (such as oral ulcers, rashes, etc.), eye lesions (such as conjunctivitis, iritis, etc.), hepatobiliary diseases (such as cholangitis, cholelithiasis, etc.), thromboembolic diseases, etc. These manifestations are similar to other diseases and need to be carefully identified.

It is worth noting that perianal lesions are also one of the common complications of Crohn's disease. Symptoms such as perianal abscesses and perianal fistulas may become the first symptoms of some patients. These symptoms may be one of the signs of Crohn's disease.

The disease is complex to diagnose and treat, recurs repeatedly, has a long course, and is difficult to cure. Although it is not fatal, it seriously affects the patient's quality of life, so it is called "green cancer."

2. What auxiliary examinations can help diagnose Crohn's disease?

Crohn's disease is a complex disease, and there is currently no gold standard for diagnosis. The following are several important auxiliary examination methods for Crohn's disease:

① Laboratory examination

Including routine blood tests, erythrocyte sedimentation rate, C-reactive protein, fecal calprotectin, etc. These indicators can help doctors understand the patient's systemic inflammatory response.

In addition, fecal occult blood test is also an important laboratory test. The results of fecal occult blood test in patients with Crohn's disease are often positive, indicating that the stool may contain pus cells or red blood cells.

② Endoscopic examination

Endoscopic examination is an important basis for diagnosing Crohn's disease. This examination can detect characteristic changes of Crohn's disease and can also take biopsies from the lesions to more accurately identify the early lesion characteristics of Crohn's disease and assess the extent and severity of the lesions.

If necessary, the doctor will also perform a small intestine endoscopy to obtain information about small intestinal lesions.

③ Histopathological examination

Mucosal biopsy can reveal characteristic pathological manifestations of Crohn's disease, such as fissure ulcers and non-caseating granulomas, which are helpful in diagnosing Crohn's disease.

④Imaging examination

Small intestinal CTE or MRE is an important examination for evaluating inflammatory lesions of the small intestine. It can reflect the inflammatory changes of the intestinal wall, the location and range of the lesion distribution, the presence and possible nature of stenosis, and extraluminal complications. In addition, endoscopic ultrasound can show the location and range of intestinal wall lesions, intestinal stenosis, intestinal fistulas, and abscesses.

In short, the diagnosis of Crohn's disease requires a comprehensive analysis of clinical manifestations, laboratory tests, endoscopic examinations, imaging examinations, and pathological histological examinations.

3. What should I do if I find I have Crohn’s?

Since there is no clear cause of the disease, there is also a lack of effective cure. Currently, drug treatment is mostly used clinically to control the disease, prevent complications, and prevent more serious intestinal lesions and damage.

For patients who are ineffective with drug treatment or who have severe complications such as complete intestinal obstruction, acute perforation, or uncontrollable massive bleeding, surgical treatment may be considered.

Crohn's patients should pay attention to the following in their daily life:

1. Diet management

① Try to choose foods that are high in calories and protein, such as eggs, fish, etc., to compensate for the nutritional loss caused by long-term diarrhea. The supply can be gradually increased according to the digestion and absorption tolerance.

② Vitamins and inorganic salts must be sufficient to compensate for the nutritional loss caused by diarrhea.

③ Limit fat and dietary fiber: Diarrhea is often accompanied by fat malabsorption, and in severe cases, steatorrhea. Therefore, the fat content in food should be limited, and less oily food and less oily cooking methods should be used. For those with steatorrhea, medium-chain fatty acid oils can be used.

Avoid eating foods high in irritants and fiber, such as spicy foods, sweet potatoes, carrots, celery, leeks, raw vegetables, fruits, and irritating onions, ginger, garlic, coarse grains, dry beans, etc. You can eat some meat with low fat content such as chicken and fish.

④ Eat small meals frequently: reduce the burden on the intestines. You can cross-consume nutritional powders such as Ansu and Energizer to supplement nutrition.

2. Maintain good living habits

① Carry out appropriate physical exercise to improve your physical fitness. It is advisable to exercise 3-7 days a week for about 30 minutes each time. You can choose the exercise that suits you according to your physical fitness.

② Quit smoking and drinking. Tobacco and alcohol can irritate the body and are not good for your health.

3. Maintain an optimistic and positive attitude

Relaxing, avoiding excessive stress, and promptly relieving negative emotions can ensure the normal functioning of the nervous and digestive systems, contribute to the stability of the body, and reduce the incidence of Crohn's disease.

4. Regular review

Crohn's disease patients need to undergo regular intestinal examinations and blood routine tests, fecal calprotectin, liver and kidney function tests, etc. The general follow-up period is 1-3 months (2-4 weeks during the active disease period, 1-3 months during the remission period). If the disease is particularly stable, a follow-up examination can be conducted every 6-12 months to promptly detect changes in the disease and signs of recurrence.

Doctors remind that for Crohn's patients with anal fistula and perianal abscess, surgical treatment should be timely. After Crohn's disease is under control, appropriate surgical methods should be adopted according to the condition. Minimally invasive surgery is recommended to protect the function of the anal sphincter. In addition to surgical treatment, oral Chinese medicine, sitz baths, retention enema and other treatments can effectively promote wound repair.

Hunan Medical Chat Special Author: Lin Du from Changsha Fourth Hospital

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(Edited by YT)