Summary
Definition
Anamnesis y examen
Principales factores de diagnóstico
- pain on defecation
- tearing sensation on passing stool
- fresh blood on stool or on paper
- anal spasm
Otros factores de diagnóstico
- intermittent symptoms
- sentinel pile
- fissure visible on retraction of buttock
Factores de riesgo
- hard stool
- pregnancy
- opiate analgesia
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- clinical diagnosis
Pruebas diagnósticas que deben considerarse
- anal manometry
- anal ultrasound
Algoritmo de tratamiento
on presentation
resistant fissures
Colaboradores
Autores
Nivedh Paluvoi, MD
Assistant Professor of Surgery
Colorectal Surgery
Miller School of Medicine
University of Miami
Coral Gables
FL
Divulgaciones
NP declares that he has no competing interests.
Agradecimientos
Dr Nivedh Paluvoi would like to gratefully acknowledge Dr John R. T. Monson, Dr John Scholefield, and Dr Jonathan Lund, previous contributors to this topic. JRTM declares that he has no competing interests. JS and JL are authors of a number of references cited in this topic.
Revisores por pares
Stephen H. Leveson, MD, FRCS
Professor
York Hospital
York
UK
Divulgaciones
SHL declares that he has no competing interests.
Steven Brown, MD, FRCS
Consultant Colorectal Surgeon
Northern General Hospital
Sheffield
UK
Divulgaciones
SB declares that he has no competing interests.
Jan Rakinic, MD, FACS, FASCRS
Associate Professor of Surgery
Chief
Section of Colorectal Surgery
Southern Illinois University School of Medicine
Springfield
IL
Divulgaciones
JR is an author of a reference cited in this topic.
Referencias
Artículos principales
Gilani A, Tierney G. Chronic anal fissure in adults. BMJ. 2022 Jan 12;376:e066834.
Lund JN, Nystrom PO, Coremans G, et al. An evidence-based treatment algorithm for anal fissure. Tech Coloproctol. 2006 Oct;10(3):177-80. Resumen
American Gastroenterological Association. American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure. Gastroenterology. 2003 Jan;124(1):233-4.Texto completo
Davids JS, Hawkins AT, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anal fissures. Dis Colon Rectum. 2023 Feb 1;66(2):190-9.Texto completo
Menteş BB, Irkörücü O, Akin M, et al. Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum. 2003 Feb;46(2):232-7. Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Crohn disease
- Sarcoidosis
- Extrapulmonary Tuberculosis
Más DiferencialesGuías de práctica clínica
- Clinical practice guideline for the management of anal fissures
- Consensus guidelines in emergency colorectal surgery
Más Guías de práctica clínicaFolletos para el paciente
Anal tears
Más Folletos para el pacienteInicie sesión o suscríbase para acceder a todo el BMJ Best Practice
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