Document Detail

Anorectal fissures: an under-recognized cause of low back pain? Case report.
MedLine Citation:
PMID:  20217995     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Low back pain is one of the most common complaints for which patients seek medical attention. The differential for such a complaint is wide and therefore requires a thoughtful and thorough work-up. Anorectal disorders are an often-overlooked cause of low back pain. CASE PRESENTATION: We discuss the case of a 46-year-old male with history of dull aching back pain in the midline at the lumbosacral junction. The pain extended to the left of midline, into the region of the sacroiliac joint. There was no radiation into the buttock or leg. Physical exam was unremarkable. Upon soliciting further history, the patient reported a long history of anal pruritus and occasional hematochezia. Colonoscopy subsequently revealed anal fissures in various stages of healing. He was treated with Metamucil capsules and oral nifedipine with significant improvement of his symptoms. CONCLUSION: Low back pain is a challenging chief complaint to the primary care diagnostician due to its wide differential. In a careful and thorough work-up of this complaint, disorders of the anus and rectum should not be overlooked as possible culprits.
Kristopher T Kimmell; Jason Lees; Mason B Andrews; Craig H Rabb
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of the Oklahoma State Medical Association     Volume:  103     ISSN:  0030-1876     ISO Abbreviation:  J Okla State Med Assoc     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-03-11     Completed Date:  2010-04-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503043     Medline TA:  J Okla State Med Assoc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-2     Citation Subset:  IM    
College of Medicine, University of Oklahoma, Oklahoma City, USA.
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MeSH Terms
Administration, Oral
Cathartics / administration & dosage,  therapeutic use
Diagnosis, Differential
Drug Therapy, Combination
Fissure in Ano / complications*,  diagnosis,  drug therapy
Follow-Up Studies
Low Back Pain / diagnosis,  drug therapy,  etiology*
Middle Aged
Nifedipine / administration & dosage,  therapeutic use
Psyllium / administration & dosage,  therapeutic use
Vasodilator Agents / administration & dosage,  therapeutic use
Reg. No./Substance:
0/Cathartics; 0/Vasodilator Agents; 21829-25-4/Nifedipine; 8063-16-9/Psyllium

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