Pediatric Surgery for Anal Fissure Workup

  • Author: Brian P Gillett, MD; Chief Editor: Philip Glick, MD, MBA   more...
 
Updated: Mar 2, 2010
 

Laboratory Studies

  • Laboratory and imaging studies are not routinely necessary in the workup of an anal fissure. However, if the clinician suspects the presence of an underlying disease process, additional tests are indicated, such as serology, purified protein derivative of tuberculin (PPD), stool cultures, biopsy, or further GI workup.
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Imaging Studies

  • An abdominal flat radiograph to check for constipation is often illustrative and serves as a baseline examination before beginning stool softeners.
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Contributor Information and Disclosures
Author

Brian P Gillett, MD  Assistant Professor, Department of Emergency Medicine, SUNY Downstate Medical Center and Kings County Hospital Center

Brian P Gillett, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Charles N Paidas, MD, MBA  Professor of Surgery and Pediatrics, University of South Florida; Chief of Pediatric Surgery, Tampa General Hospital

Charles N Paidas, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American College of Surgeons, American Heart Association, American Pediatric Surgical Association, Association for Academic Surgery, Florida Pediatric Society, Johns Hopkins Medical and Surgical Association, Society of Critical Care Medicine, and Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Aviva L Katz, MD  Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh

Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Gail E Besner, MD  John E. Fisher Endowed Chair in Neonatal Reseach, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine; Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital

Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Philip Glick, MD, MBA  Professor, Departments of Surgery, Pediatrics, and Gynecology and Obstetrics, Vice-Chairperson for Finance and Development, Department of Surgery, State University of New York at Buffalo

Philip Glick, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, Central Surgical Association, Federation of American Societies for Experimental Biology, Medical Society of the State of New York, Phi Beta Kappa, Physicians for Social Responsibility, Royal College of Surgeons of England, Sigma Xi, Society for Pediatric Research, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, and Society of University Surgeons

Disclosure: Nothing to disclose.

References

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  2. Demirbag S, Tander B, Atabek C, et al. Long-term results of topical glyceryl trinitrate ointment in children with anal fissure. Ann Trop Paediatr. Jun 2005;25(2):135-7. [Medline].

  3. Agnarsson U, Warde C, McCarthy G, Evans N. Perianal appearances associated with constipation. Arch Dis Child. Nov 1990;65(11):1231-4. [Medline].

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  8. Jonas M, Neal KR, Abercrombie JF, Scholefield JH. A randomized trial of oral vs. topical diltiazem for chronic anal fissures. Dis Colon Rectum. Aug 2001;44(8):1074-8. [Medline].

  9. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. Jan 1989;32(1):43-52. [Medline].

  10. Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg. Apr 2001;88(4):553-6. [Medline].

  11. Motson RW, Clifton MA. Pathogenesis and treatment of anal fissure. In: Henry MM, Swash M, eds. Coloproctology and the Pelvic Floor. Butterworth-Heinemann; 1985:340-9.

  12. Parellada C. Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up. Dis Colon Rectum. Apr 2004;47(4):437-43. [Medline].

  13. Pena A. Surgical conditions of the anus, rectum, and colon. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: WB Saunders Co; 2000:1181-3.

  14. Shafik A. A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. XV. Chronic anal fissure: a new theory of pathogenesis. Am J Surg. Aug 1982;144(2):262-8. [Medline].

  15. Sonmez K, Demirogullari B, Ekingen G, et al. Randomized, placebo-controlled treatment of anal fissure by lidocaine,EMLA, and GTN in children. J Pediatr Surg. Sep 2002;37(9):1313-6. [Medline].

  16. Stafford PW. Anal fissure. In: O'Neill JA, Rowe MI, Grosfeld JL, et al, eds. Pediatric Surgery. Elsevier Health Sciences; 1998:1454-5.

  17. Tander B, Guven A, Demirbag S, et al. A prospective, randomized, double-blind, placebo-controlled trial of glyceryl-trinitrate ointment in the treatment of children with anal fissure. J Pediatr Surg. Dec 1999;34(12):1810-2. [Medline].

 
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