Fissura ani
-
ulceration elliptical in shape, located below the linea
dentata on the posterior commissure (usually solitary, rarely it is anterior -
the so-called rectal erosion), can be:
acute – superficial crack with sharp edges, at the base of the
fibre of the internal sphincter
chronic – arises from acute after 3 days as an ulcer with rolled
edges and a flaccid base, distally a so-called guarding bump formed by
granulation tissue is prominent, proximally there is a hypertrophic anal
papilla
- is caused by several factors -
mechanical (traumatization by hard stool), increase in resting sphincter tone, inflammation, food composition …
https://www.chirurgia.name/sites/default/files/stranky/fissura.png
clinical symptoms
and diagnosis
-
intense pain arising on stool and persisting for
several hours, bleeding of varying intensity
-
examination by aspiration, per rectum palpation,
anoscopy (often requiring anaesthesia), in case of bleeding coloscopy or
irrigography to exclude tumour, ulcerative colitis, m. Crohn's disease,
venereal disease (especially if localization is elsewhere than in the anterior
commissure)
treatment
1.) acute anal
fissure - affect sphincter pain and spasm
-
injection of botulinum toxin into the internal
sphincter
-
surgical only if conservative treatment is refractory
for 3-4 weeks
2.) chronic anal
fissure
-
divulse of the anus under general anaesthesia -
reduction of sphincter tension and tearing of the fissure edges (blood supply -
heals better)
-
excise fissure and guard bump, let granulate
- lateral internal sphincterotomy (Parks) - the method of choice. The length of the tomia should correspond to the length of the fissure. The incision is made intersphincterically and the mucosa is not affected
https://emedicine.medscape.com/article/1582334-technique