Cases reported "Fissure in Ano"

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1/14. Atypical presentation of herpes simplex virus in a patient with chronic lymphocytic leukemia.

    Perianal infections caused by herpes simplex virus are common in immunocompromised patients. The cutaneous presentation in these patients is often atypical, overlaps with the clinical features of other diseases, poses a difficulty in diagnosis, and responds poorly to treatment. An immunocompromised patient with chronic lymphocytic leukemia, treated with oral corticosteroids, presented with chronic perianal ulcerations. This patient was referred for evaluation and treatment of "recalcitrant" pyoderma gangrenosum. Prompt diagnosis was possible when the clinical features were recognized and appropriate biopsy and cultures were obtained. We describe an atypical presentation of herpes simplex virus associated with both an endogenous and exogenous induced immunodeficiency, and stress the importance of routinely performing cultures on all perianal ulcerations and anal fissures to avoid the misdiagnosis, inappropriate treatment, and prolonged discomfort of these afflicted patients.
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2/14. Perianal and gluteal burns as a complication of hot water bottle treatment for anal fissure.

    Contact with hot objects and surfaces often causes burns. We present a case of burns to the buttock and perineum caused by use of a hot water bottle to relieve the pain caused by an anal fissure.
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3/14. Anal injury and fissure-in-ano from sexual abuse in children.

    Ano-rectal injuries in children are generally uncommon, and those caused by sexual abuse are rarely reported in our environment. This is a report of two children aged 5 and 12 years who sustained anal injuries following anal sexual abuse. Both presented late with fissure-in-ano and were managed conservatively. Though fissure-in-ano is not uncommon in children, it might be necessary to exclude sexual abuse and undertake appropriate evaluation and treatment. The child must be protected from further abuse.
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ranking = 6
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4/14. Perianal acquired tufted angioma associated with pregnancy: case report.

    Tufted angiomas are rare lesions described as slowly growing/spreading erythematous macules especially located in the upper trunk and neck. Herein we report the case of perianal location of a tufted angioma in a young pregnant woman. She came to our observation complaining of perianal pain accompanied by bleeding at defecation. A lesion resembling a perianal fissure was observed. Mild hypertonia of the internal sphincter was confirmed at manometry. After one week of ineffective medical treatment, surgery was planed at the end of the sixteenth week under local anaesthesia. The lesion was excised and a minimal sphincterotomy was performed; histopathology report described features of a tufted angioma. The pregnancy proceeded regularly, without anal symptoms, followed by normal vaginal delivery at the thirty-eighth week. This case showed three peculiar features: the association of tufted angioma and pregnancy, the perianal location, and the clinical appearance suggestive of an anal fissure. The clinical manifestation of a perianal tufted angioma, mimicking an anal fissure, is of utmost importance to the differential diagnosis and treatment plan, especially in a pregnant woman.
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5/14. dicyclomine for medical management of persistent anal fissure with associated spasm of the internal sphincter.

    The case of a 43-year-old woman with persistent anal fissure responsive to dicyclomine is described. Associated spasm of the internal sphincter had precluded fissure healing. The spasm of the internal sphincter relaxed within 24 hours of dicyclomine administration and subsequently allowed healing. Surgery was avoided.
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ranking = 6
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6/14. Early results of a rotational flap to treat chronic anal fissures.

    BACKGROUND: Treatment of anal fissures has changed dramatically in the past decade. Only a few fail to respond to medical therapy. Sphincterotomy and anal dilatation have fallen out of favour due to the risk of incontinence. Island flaps have been proposed to address this, but 60--70% of flap donor sites break down with complications. We proposed that using a rotational flap would overcome this problem.methods: Twenty-one patients (14 women,7 men) with chronic anal fissures were treated with rotation flap from perianal skin. The median age was 43 (range 21--76) years. All patients had failed chemical sphincterotomy and showed no signs of improvement following at least a 3-month course of topical GTN 0.2% ointment.RESULTS: The median hospital stay was 2 days. Seventeen patients had complete resolution of symptoms. Only one patient continued to have severe pain. Two developed a recurrent fissure. One patient had a combined fistula-fissure complex at diagnosis and suffered from a breakdown of the flap and donor site. Another patient had had haemorrhoidectomy and an advancement flap in the past. He developed problems with the donor site, which was successfully managed conservatively. One patient had persistent mild pain after surgery, but the cause could not be found. None of the patients suffered continence defects after surgery.CONCLUSION: Use of a rotational flap is a simple, safe and successful treatment for anal fissures. Donor site problems are minimised using this approach. It should be a treatment of choice when surgery is required for chronic anal fissures, particularly in patients in whom there is a risk of incontinence.
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ranking = 10
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7/14. Currarino syndrome associated with penoscrotal inversion and perineal fissure.

    We present an unusual case of Currarino syndrome with a mucosa-lined deep perineal fissure extending to the sacrum, penoscrotal transposition, perineal hypospadias, and a penile ventral skin defect. The child had a sigmoid diverting colostomy because of high anal atresia. magnetic resonance imaging illustrated absence of the levator ani and muscle complex in the pelvis. At 15 months, perianal examination pointed out a fistula orifice and a sac related to the fistula at the left side of the perineal fissure. The fistula, a fluid-filled sac extending to the sacrum, and mucosa overlying the perineal fissure were removed en bloc. The neck of the sac was ligated and divided at the level of the distal sacrum. In the same session, a Glenn-Anderson procedure was performed for penoscrotal transposition, and the penile chordee was released. X-ray showed a bony deformity of the sacrococcygeal region in the shape of a scimitar. Histopathological examination demonstrated that the sac contained glial neuronal islands and nerve fibers. The boy has no neurologic deficits and seems to be well. To our knowledge, these associated malformations are extremely rare.
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ranking = 7
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8/14. Perianal infection with group A streptococcus.

    Anal fissure in childhood usually heals quickly after treatment with stool softeners and a local anaesthetic ointment; infection does not usually occur. Two cases are reported in which Lancefield group A beta haemolytic streptococci were isolated from cultures from the perianal skin, which was erythematous and excoriated.
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9/14. Tuberculous anal ulcer.

    Two patients with anorectal tuberculosis, without prior or concurrent knowledge of active pulmonary infection with mycobacteria, are described. Anal fissure in an unusual location which is slow to heal should have a biopsy performed, with appropriate stains and cultures carried out, to rule out tuberculous disease. Chemotherapy is then highly effective for ulcerative perianal tuberculosis.
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10/14. Mild form of neonatal necrotizing enterocolitis masked by anal fissures.

    In three infants with clinically mild necrotizing enterocolitis, heme-positive stools were initially attributed to anal fissures, delaying diagnosis and treatment of the enterocolitis for 4-10 days. Radiographically, pneumatosis intestinalis involved the entire colon and rectum. A causal relation may exist between necrotizing enterocolitis and anal fissure.
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ranking = 6
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