Concluded Case

6 yrs F constipation since 1 yr pt told parents about pain during defecation but they ignore it since 1 yr seen before 5 days Plz Dx n Rx

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Classical presentation of a sentinel pile , indicative of a scar tissue of a chronic fissure in ano presenting as external anal swelling, mostly seen in patients with chronic constipation as in this case . There must be a hypertrophied anal papilla just adjoining sentinel pile inside anal canal . Chronic fissure is difficult to treat. Treatment- Antibiotics- Amoxyclav 375 mg B.D for 7 days Laxative- polyethylene glycol 2 tsf O.D for 1 month. A high fibre diet . Sentinel pile cannot be treated conservatively. It can be only excised. but generally it is not required. Sitz bath over prolonged period can help.

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Classical presentation of a sentinel pile , indicative of a scar tissue of a chronic fissure in ano presenting as external anal swelling, mostly seen in patients with chronic constipation as in this case . There must be a hypertrophied anal papilla just adjoining sentinel pile inside anal canal . Chronic fissure is difficult to treat. Treatment- Antibiotics- Amoxyclav 375 mg B.D for 7 days Laxative- polyethylene glycol 2 tsf O.D for 1 month. A high fibre diet . Sentinel pile cannot be treated conservatively. It can be only excised. but generally it is not required. Sitz bath over prolonged period can help.

Thanks for sharing this case Dr. Ram Golde
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Sentinel pile Fissures are usually caused by trauma to the inner lining of the anus. ... Chronic fissures may be more difficult to treat and may also have an external lump associated with the tear, called a sentinel pile or skin tag, as well as extra tissue just inside the anal canal, referred to as a hypertrophied papilla.

A skin tag over a chronic fissure. The child has to be treated for constipation.
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External Hemorrhoids.. RX.. Appropriate antibiotics with Nsaid.. Lactulose for constipation.. Fibrous food.. Fruits & vegetables.. Experts opinion..

Thank you doctor
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Looks like sentinel piles. Still, Opinion from paediatric surgeon should be taken as the history of constipation and pain during defecation is long, to rule out any anatomical/functional problem

Chronic anal fissure with ? thrombosed external piles Sitz bath Avoid constipation High fiber rich diet Stool softner Lignocine belly to apply locally.

As per my opinion This is a case of 2nd to 3rd degree internal haemorrhoids @ 11 o’clock position with spasmodic anus. This will occur may be history of straining at stool since many years. Please ask about that with her parents. What is bleeding history when passing stool..?? If yes then surgical intervention is needful. Closed haemorrhoidectomy with lord’s procedure under SA. Thank you sirji for sharing this interesting case.

Thank you doctor
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Grade 3 haemorrhoides /external piles.Sentinal pile useually present at posterior midline.It is sign of chronic anal fissure.Surgery is the prime management in this case.

Sentinel pile

Sentinel pile foll a hard stool with fissure in ano. Treat her for functional constipation with regular follow up , And it will self resolve.

Internal fissures,? Sentinel piles,.After appropriate investigation should go for surgical procedure

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