Perianal disease

Question 1

Anal Fissure
DDx

Answer 1

Linear and midline
90% posterior
chronic >6 wk

DDx:
Trauma
Hypertonic internal & external sphincter
Child abuse
Perianal CD
Lymphoma
Chronic constipation
Infection/STD

Question 2

Rx of anal fissure

Answer 2

stool softeners
sitz bath
proper hygiene
topic steroids (not useful for healing)
Topical nitroglycerin
Surgery (anal sphincterotomy if failed to heal)