Introduction
Pruritus ani is one of the most common diseases among benign anorectal disease group encountered in the society. The men/women incidence of this disease which affects one out of every twenty people in the society is 4.1 Various factors such as personal hygiene, obesity, wearing tight clothing and psychogenic causes play a role in the etiology of idiopathic pruritus ani. Skin biopsy should be done first for diagnosis. After the secondary causes are ruled out, the initial treatment should be administered to the patient for 2-4 weeks. In this treatment, first of all, topical irritants (stool contamination, soap, perfume, etc.) should be eliminated and excessive anal hygiene habits should be avoided. The consumption of food products such as coffee, soda and alcohol should be reduced. Afterwards, topical steroids and oral antipruritic agents should be used in decreasing doses for 4-8 weeks. A method that has been used with increasing frequency recently is methylene blue injection into the perianal skin. In this method, 8 ml of 2% methylene blue is mixed with 0.5% lidocaine in the same volume and injected into the perianal dermis with a 22 gauge needle and it has been shown that the possibility of complications such as skin necrosis is low, when the method is applied correctly.2 In this video presentation, a patient with pruritus ani, who was unresponsive to medical treatment, was administered methylene blue injection treatment with the described technique.
No preoperative preparation was made for the patient. Prophylactic antibiotherapy or enema was not applied in the preoperative period. The patient underwent surgery in the prone jack-knife position. Eight cc of 2% methylene blue was mixed with 8 cc 0.5% lidocaine and injected intradermally to the entire perianal area using a 22 gauge needle and the procedure was terminated.
In conclusion, we think that in patients with pruritus ani refractory to conservative treatment, injection of methylene blue into the perianal region is a cheap, easy-to-apply and satisfying method for patients.
* This video presentation was recorded at the proctology course held at University of Health Sciences Turkey, Ümraniye Training and Research Hospital on 17.10.2020.
https://www.doi.org/10.4274/tjcd.galenos.2020.2020-11-2.video2
Informed Consent: Obtained.
Peer-review: Externally and internally peer reviewed.
Authorship Contributions
Surgical and Medical Practices: MK.Y., M.F.P., Concept: M.K.Y., Design: F.T., A.Y., Data Collection or Processing: F.T., Analysis or Interpretation: M.K.Y., M.F.P., Literature Search: M.K.Y. A.T., Writing: M.K.Y., A.T.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.