A study of suppurative pathologies associated with chronic anal fissures

Abstract

Suppuration in chronic anal fissure seems to be more frequent than described. While dealing with the anal fissure, it is desirable to look for and attend to these associated pathologies, especially to avoid complications and morbidity of the primary disease.

Combined treatment approach to chronic anal fissure with associated anal fistula

“…A chronic anal fissure is one that persists beyond 6–8 weeks and usually shows features of chronicity including a hypertrophied anal papilla at cranial end of the fissure, a sentinel tag at its caudal aspect and exposed internal anal sphincter muscle within the base of the fissure . A small number of studies have now challenged the belief that chronic anal fissure is the result of ischaemia, with perianal sepsis proposed as an alternative theory . Instead deep fissures may erode into the sphincter fibres with the hypertonicity of the internal sphincter postulated to be a bystander effect, due to infection and inflammation rather than the cause of the fissure .…”

“…The mechanism by which an anal fistula develops from a fissure is thought to be due to healing of the distal extent of the fissure with formation of a skin bridge allowing faecal matter to track deep to it (Fig. ) . The exact aetiology for chronic anal fissure is unknown; however, the most commonly accepted theory is ischaemia .…”

“…The exact aetiology for chronic anal fissure is unknown; however, the most commonly accepted theory is ischaemia . There are small numbers of recent observational studies that challenge the idea that chronic anal fissure is due to ischaemic ulceration . One such proposed theory is that a fissure may persist due to underlying submucous or intersphincteric sepsis.…”

S3-Leitlinie: Analabszess

“…Bei subanodermaler Lage kann ein perianaler Zugang mit oder ohne Fistelspaltung gewählt werden.Eine Sonderform des intersphinkteren Abszesses stellen Abszesse auf dem Boden einer chronischen Analfissur dar. Gupta[32] fand bei 532 Patienten mit einer chronischen Analfissur in 16,5% einen Abszess, der in 70% der Fälle posterior lokalisiert war.Die Drainage des supralevatorischen Abszesses kann transrektal oder perianal erfolgen. Wichtigstes diagnostisches Verfahren ist die Endosonographie, die darstellen kann, ob die Muskelplatte des M. levator ani intakt ist.…”

Ultrasonographic assessment of patients referred with chronic anal pain to a tertiary referral centre

“…This may also be reflective of the greater anatomical disposition of anal glands posteriorly [28,29]. In this setting, the use of various forms of ultrasonography in the clinical setting (in particular, static and dynamic transperineal sonography) has also shown advantage in the delineation of other diagnoses such as rectoanal intussusception and enterocele which may conceivably contribute to perianal pain and painful defecation [30].…”