Lateral Internal Sphincterotomy
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Lateral Internal Sphincterotomy- Management of Anal Fissures (2023)
Anal Fissure and Anal Stenosis
Anorectal Disease- A 55-year-old man who underwent an excisional hemorrhoidectomy 6 weeks ago presents with feelings of constipation, rectal pressure, and straining during bowel movement. He states his stool has become progressively thin. On digital rectal examination, he has mild anal stenosis. What is the initial step in management?
- A 28-year-old man presents for follow-up of a painful posterior midline anal fissure that has not improved after fiber supplementation and a 6-week course of topical diltiazem 2%. On examination, he has a chronic posterior midline fissure and a hypertonic sphincter. What is the best next course of action?
- A 28-year-old woman with perianal Crohn’s disease is referred for evaluation for perianal itching. On examination, she has large bilateral anal skin tags that are painless to palpation. What is the most appropriate treatment?
- A 55-year-old postmenopausal woman presents to your office with severe anal pain, bleeding, and urgency with liquid bowel movements. On examination, she has a mildly tender chronic, anterior midline anal fissure and decreased sphincter tone. What is your best treatment recommendation?
- A 67-year-old patient presents with a 2-year history of recurrent hemorrhoid swelling, difficulty cleaning, and bright red blood with bowel movements despite fiber supplementation and avoidance of straining. Examination reveals grade III hemorrhoids with a large external component. Which of the following would be the most effective treatment?
Anorectal Disease- Pediatric Colorectal Disorders
- Anorectal Crohn’s Disease