Among the patients who visited the clinic recently, there was one special patient, which was a patient with old anal fissure with fissure hemorrhoids and anal papilla hypertrophy. Anal fissure is a small ulcer formed after laceration of the skin layer of the anal canal below the dentate line. Its direction is parallel to the longitudinal axis of the anal canal. It is generally about 0.5 to 1.0 cm long. It is fusiform or elliptical and often causes severe pain and difficult healing. Anal fissure is an independent disease. Its special clinical manifestations are: severe pain, predominantly in the posterior midline, low healing rate, lack of granulation tissue, lack of skin growth in the crack, high pressure in the anal canal, and often accompanied by hypertrophy of the anal papilla Sentinel hemorrhoids (ie split hemorrhoids).
Introduction to the special case: Zou, female, 39 years old
The patient had intermittent blood in the stool for more than 10 years. It takes one year to recover the tissues in the anus during defecation. It takes about 1 time a day to defecate for 5-10 minutes each time. Recently, the stool is not dry and hard. The stool is bloody and bright red, mostly dripping blood, blood on the surface of the stool and wipe blood on toilet paper, no pain. Check the anal margin, see the epidermis at 6 and 12 o’clock; finger check the anus, lower rectum (-), the anterior wall of the anorectal junction and long strip vegetation, the texture is tough, about 2.0cm long, painful, and the finger cots are clean ; Anoscopy revealed a crack in the anterior wall of the anal canal, about 0.5 cm long, fusiform-shaped, red in color, and slightly to moderately raised mucosa on the dentate line. Three gray-white anal papillae with roots in the anterior wall were seen on the front wall. Extra-anal.
The patient finally agreed to the operation, and we immediately performed a preoperative check. In the afternoon, he was surgically removed under local infiltration anesthesia.