Secondary anal fissures: a pain in the a**

Abstract

An anal fissure is a painful tear of the sensitive anoderm, distally from the dentate line. It is a prevalent disorder and impairs quality of life dramatically. Typical or primary fissures are associated with constipation and mostly located at the posterior midline. About 1% of fissures are atypical in appearance and are generally secondary in nature. These secondary fissures should arouse attention and require further exploration for underlying conditions, such as Crohn’s disease, malignancy, trauma or venereal infections. The aim of this manuscript is to provide a comprehensive review on the clinical aspects, evaluation and treatment of secondary anal fissures.

Anorectal Infections in Neutropenic Leukemia Patients: A Common Clinical Challenge

“…The differential diagnosis of anorectal pathologies in neutropenic leukemia patients is broad. In patients with nonhealing ulcerations in the perianal area with a poor response to antibiotics, it is important to consider other causes, as outlined in Table 1 [45]. Examples include herpes simplex infections, which often fail to exhibit vesicular lesions due to profound neutropenia or leukemic infiltrations of the perineal area [16, 28,45].…”

“…General anti-infective recommendations for high-risk patients include antibacterial prophylaxis with fluoroquinolones, Table 1. Differential Diagnosis of Non-Healing Perianal Lesions in Cytopenic Patients With Leukemia [28,45] Sexually transmitted diseases (human papilloma virus, herpes simplex virus, syphilis, chlamydia, gonorrhea, Hemophilus ducreyi) antiviral prophylaxis with acyclovir or valacyclovir to prevent reactivation of the herpes virus and anti-fungal prophylaxis [39,41]. Antifungal prophylaxis with a triazole is indicated in patients with an ANC < 100/µL lasting more than seven days.…”

Essential reading from the editor’s desk

“…Bosman and colleagues from Leuven have performed a comprehensive review on the efficacy of neuromodulators in functional dyspepsia which is published in the current issue (8). Another comprehensive review was written by Hannes Ruymbeke and colleagues from multiple Belgian centers on secondary anal fissures, an important topic, that many physicians are less well-versed in (9). Also in this issue, Maly and colleagues describe their experience with the 'balloon dilation pull' technique for the treatment of buried bumper syndrome in patients with a percutaneous endoscopy gastrostomy (PEG) (10).…”