الفهرس Only 14 pages are availabe for public view
 |  | from | 138 |  |  |
| | | from | 138 | | |
Abstract
Discussion Anal fissure is a linear crack or tear in the squamous epithelium of the lower half of the anal canal, usually extending from below the dentate line to the anal verge.. (Edward et al., 2005). Fissures occur in all age groups, it represents 10% of all outpatient visits. (Cintron & Pino,1996).
Anal fissure is clinically differentiated into acute and chronic. An acute anal fissure will heal spontaneously or in response to medical treatment, on the other hand chronic anal fissure is a recurrent painful condition.
It starts as a crack in the mucous membrane of the anal canal over the lower third of the internal anal sphincter.
Secondary infection,skin tag, hypertrophy of the anal papilla, fibrous induration of the edges,spasm and fibrosis of the internal anal sphincter occur later and usually no healing without intervention.( Michael et al, 1993).
The point at which an acute anal fissure becomes chronic is contentious, but published work suggest symptoms lasting for more than two months are undeniably chronic.( Lund et al, 1996)The origin of the anal fissure is still unknown.
Numerous theories have been introduced to unravel the underlying cause of this painful condition. Most of these theories are conflicting and non of them give satisfactory explanation for the characteristic features of the chronic anal fissure. (Schouten et al,1996)It is believed that traumatic laceration of the anoderm is the major initiating factor.
In individuals with normal anal pressures, such alaceration will heal spontaneously.
In patients with a pre-existing rise in the internal sphincter tone ( possibly caused by stress), raising the maximum anal resting pressure(MARP), traumatic lesions of the anoderm heal poorly.
This failure to heal is mainly caused by impaired perfusion of the anoderm, especially at the midline posteriorly, which finally results in ischemic ulceration.
The ischemic nature of the anal fissure explains the characteristic features of this painful condition. ( Schouten et al.,1994)Reduction of anal pressure by sphincterotomy improves anodermal blood flow at posterior midline resulting in fissure healing.
This finding provides evidence of the ischemic nature of anal fissure. So there’s strong evidence that nitric oxide plays a major role in mediating relaxation of internal anal sphincter. (Rattan et al., 2005)The severe constant, and commanding pain of chronic anal fissure that present for weeks and months pushes the surgeon to offer a quick and simple solution to pain which is surgical sphincterotomy, however post operative continent condition is an important drawback of the operation.
In our study treatment of the chronic anal fissure was tried by either local application of 0.2% Glyceryl Trinitrate or by lateral internal sphincterotomy.
The study was done on 50 patients divided into 2 groups, with 24 males and 26 females. The ages of the patients involved in this study ranged from 18-55 years old with the mean age of 33.64 years old.