Perianal burn as a complication of hemorrhoid treatment caused by hot water sitz bath

Abstract

1. Case Report A 52-year-old female was admitted to the Clinic of Plastic and Reconstructive Surgery for treatment of a perianal scald burn. She was injured by hot water sitz bath during the symptomatic treatment of hemorrhoid. In the last 10 years, she had been suffering from impaired sensation caused by herniated intervertebral discs between fourth lumbar to fifth sacral spinal levels and had been operated several times for decompression in the past. Recently, she used to have painful defecation and constipation periods and admitted to the Clinic of Proctology that she was diagnosed as having hemorrhoidal disease so she was given a nonoperative and symptomatic treatment for her complaints. During the therapy, bathtubs were filled with hot water and used for sitz baths to reveal symptoms of hemorrhoid. However, she suffered injury to her perianal region involving deep partial and full thickness burn. Except for the anus and anal borders, the dermatomes that were innervated by first to fifth sacral spinal nerves had been burned (Fig. 1). Before the wound debridement, fleet enema was given twice for intestinal clearance. Furthermore, an immediate wound closure was carried out with a split thickness skin graft, which was taken from her lateral thigh (Fig. 2). The skin graft dressing used moist gauze with ointment, then it was covered with a shaped stent, which was prepared from two-layered sterile sponge. The stent was fixed to the perianal and gluteal regions by tie-over sutures. A watertight environment was obtained by an adhesive drape, which covered the total surface of perianal and gluteal regions to protect the wound area. A hole was made in the center of the adhesive drape, which can into the anal orifice. After the operation, the formation of faeces was minimized with, no solid food given to the patient for three days. The stent of the wound dressing was opened the fifth day after operation. Near total take of the skin graft was seen on, but a little area was lost in the region between the posterior border of anus and sacrum. This suspicious area was allowed to heal secondarily. The anal borders and outer anal sphincter were intact. In three months of follow up, there was no problem in skin grafted and secondary healed areas. The final outcome of outer anal sphincter was satisfactory. In addition, during the wound treatment, oral antibiotherapy was given for conservative treatment.