33 y.o. Female patient presented with a 9 year history of complaints of bouts of diarrhea, sometimes with or without right sided abdominal pain. Diarrhea so severe that pt has has 2 thrombosed hemorrhoids removed in the past, multiple incidences on anal fissures with bleeding, and this that has been present for about 2 years, often it causes no symptoms, but at the current time it is causing pain. Patient was referred to GI, given lomotil for diarrhea and viscous lidocaine to apply topically. Is this a Chronic fissure or a fistula? What would be your recommendations?

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A chronic fissure in Ano. A colonoscopy is required for further evaluation to rule out ulcerative colitis, crohn's disease, Other possibilities Are Irritable bowel syndrome, malabsorption syndrome,. Since fissure is a recurring presentation, a lateral sphincterotomy should be done . Addition of Isabgol husk. Rifaximin 400mg t.d.s, a pre-probiotic, mebeverine + Chlordiazepoxide will help Also sitz bath , topical Lignocaine + metrogyl + sucralfate will help

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Since h/o diarrhoea for a pretty long time i will suggest to rule out d/d 1 pseudomembranous colitis 2 ulcerative colitis. Cause for recurrent fissures and piles is straining while defaecation which is causing to bleed.so colonoscopy can be modality to choose or ba enema should be performed.to come to diagnosis.

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Bleeding from ulcerated and thrombosed hemorrhoids. Appropriate treatment to control of CH. Diarrhoea. Correction fluid and electrolytes May require hemorrhoidectomy or anal dilatation.

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Cronic fissure in ano.

the photograph shown is perianalhematoma invstgte be enema carefulcolonoscopy biopsy a nd appropriate treatment ddulcetativecolitis reginaliltis multiplepoliposcolon putegrssyndro
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Fissure. Lat Sphincterotomy will be helpful. For diarrhea metron and Lactobacillus.

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Fissure in ano

Rule out crohn’s disease..

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Gissure in ano

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