By rray, 11 December, 2014 Surgical lateral internal sphincterotomy3 SR H minimal incision preferred LIS is surgical tx of choice for refractory fissures more efficacious than topicals or injectable tx
By rray, 11 December, 2014 Chronic features: edema/fibrosis; internal anal sphincter fibers may be seen at base; may typically see skin tag (sentinel pile) distally, hypertrophied anal papilla proximally
By rray, 11 December, 2014 Exam: longitudinal fissure; 90% are posterior midline; if lateral, consider Crohn, TB, syphilis, HIV/AIDS, derm conditions (eg, psoriasis), anal CA
By rray, 11 December, 2014 Hx: pain during/after BMs and BRBPR w/ wiping; pt may describe a “painful hemorrhoid”; anal sphincter spasm
By rray, 11 December, 2014 If no response to conservative pharmacologic tx refer for surgery or injection tx