Pediatric Surgery for Anal Fissure Differential Diagnoses

Updated: Apr 08, 2016
  • Author: Brian P Gillett, MD; Chief Editor: Philip Glick, MD, MBA  more...
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DDx

Diagnostic Considerations

The differential diagnosis includes the following:

  • Pruritus ani
  • Inflammatory bowel disease (IBD)
  • Tuberculosis
  • Inherited disorders of the immune system
  • AIDS
  • Chlamydia
  • Gonorrhea
  • Neoplasm

Also, sexual abuse should always be considered in the differential when evaluating patients with anal or genital complaints.

Most anal fissures are single in number and occur at the posterior midline. Multiple fissures of the anal canal, lateral fissures, or those that extend proximal to the dentate line should raise the suspicion of a more serious underlying disease process. Lateral fissures should raise the possibility of trauma, infection, neoplasm, AIDS, syphilis, tuberculosis, or IBD.