| Anterior anal fissures are associated with occult sphincter injury and abnormal sphincter function. | |
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MedLine Citation:
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PMID: 17655720 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The pathogenesis of chronic anal fissure (CAF) remains incompletely understood but most are associated with a high resting anal pressure and reduced perfusion at the fissure site. To date, no major distinction has been made between anterior and posterior anal fissures and their aetiology and treatment. We compared anterior and posterior fissures in patients who have failed to respond to medical treatment with respect to their underlying aetiology, anal canal pressures and sphincter muscle integrity. METHOD: Seventy consecutive patients (54 female:16 male) with a symptomatic CAF and 39 normal controls (19 female:20 male) without evidence of significant ano-rectal pathology were prospectively assessed by manometry and anal endosonography. RESULTS: Anterior anal fissures were identified in a younger age group [33 years (IQR 26-37) vs 41 years (IQR 36-52)] and predominantly in women. Anterior fissure patients were significantly more likely to have underlying external anal sphincter defects compared with posterior fissures [OR 10.9 (95% CI 3.4-35.4)]. Maximum resting pressure was not significantly elevated for anterior fissures compared with controls (P = 0.316) but was significantly elevated in posterior fissures (P = 0.005). The maximum squeeze pressure was significantly lower in the anterior fissure group [167 cmH2O (IQR 126-196) vs 205 cmH2O (IQR 174-262), P = 0.004]. A history of obstetric trauma was significantly associated with anterior fissure location [OR 13.9 (95% CI 3.4-55.7)]. CONCLUSIONS: Anterior anal fissures are associated with occult external anal sphincter injury and impaired external anal sphincter function compared with posterior fissures. These findings have implications for treatment, especially if a definitive procedure, such as lateral internal sphincterotomy, is considered. |
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Authors:
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J T Jenkins; A Urie; R G Molloy |
Publication Detail:
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Type: Journal Article Date: 2007-07-26 |
Journal Detail:
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Title: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Volume: 10 ISSN: 1463-1318 ISO Abbreviation: Colorectal Dis Publication Date: 2008 Mar |
Date Detail:
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Created Date: 2008-02-08 Completed Date: 2008-04-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883611 Medline TA: Colorectal Dis Country: England |
Other Details:
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Languages: eng Pagination: 280-5 Citation Subset: IM |
Affiliation:
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Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anal Canal / injuries*, physiopathology* Anus Diseases / complications, diagnosis, therapy Case-Control Studies Chronic Disease Endosonography Female Fissure in Ano / complications, diagnosis*, therapy Follow-Up Studies Humans Male Manometry Middle Aged Probability Prospective Studies Reference Values Severity of Illness Index Statistics, Nonparametric |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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