+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient



Chronic anal fissure from suspected adult sexual abuse in a traumatic anal sex practice patient



Acta Chirurgica Belgica 107(5): 566-569



The aetiopathogenesis of chronic anal fissure (CAF) is unclear and is probably multifactorial. CAF represents 10-15% of proctological consultations. This case report identifies adulthood sexual abuse as a significant risk and a potential aetiopathogenic factor of CAF This case history was discovered while carrying out administrated interviews during authors' clinical retrospective study on CAF. The clinical presentation of this 49-year-old woman is predominated by chronic anal lesions (anal tears in the anoderm, anal sphincter hypertrophy), associated medical history as a high consumer of healthcare with very poor mental health, chronic traumatic anal sex practice history, and especially persistent recurrences of gastro-intestinal symptoms after surgery. Surgical history is summarized as: 7x spontaneous abortion; 5x fistulectomy and 3x anal abscess; 4x Bartholin's gland; 4x hypertrophy papilla ablation; 2x anal manometry, 2x fissurectomy and 1x sphincterotomy; 2x haemorrhoid; and 1x hysterectomy. These symptoms initially started and the operations in particular took place after she was married. After 26 years of sexual abuse within her marriage, the clinical diagnosis was made and was consented by this patient. A referral to a psychiatrist was evident and a long course of multidisciplinary therapy (medical, surgical, physiological and psychological approaches) seemed to be of benefit, in terms of improving the clinical symptoms. Authors suggest that physicians should suspect sexual abuse in any patient with a medical history as a high consumer of healthcare and especially when there is persistent recurrence after the lateral subcutaneous internal sphincterotomy. We recognise that the link or causality is difficult to prove and further study is probably needed to shed light on the link between sexual abuse and CAF: although in the United Kingdom, over 20.83% of the population are subject to sexual abuse. 83%.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 052077061

Download citation: RISBibTeXText

PMID: 18074923

DOI: 10.1080/00015458.2007.11680126


Related references

Chronic anal fissure: common aetiopathogenesis, with special attention to sexual abuse. Acta Chirurgica Belgica 109(6): 720-726, 2010

Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery. Techniques in Coloproctology 7(3): 155-158, 2003

Fissurectomy and anal advancement flap for anterior chronic anal fissure without hypertonia of the internal anal sphincter in females. Colorectal Disease 12(11): 1127-1130, 2011

Anal findings in children with and without probable anal penetration: a retrospective study of 1115 children referred for suspected sexual abuse. Child Abuse and Neglect 37(7): 465-474, 2013

Anal fissure produced by examination for sexual abuse. American Journal of Diseases of Children 145(8): 848-849, 1991

Anal injury and fissure-in-ano from sexual abuse in children. Annals of Tropical Paediatrics 21(3): 273-275, 2001

Schistosomiasis in an HIV-positive patient presenting as an anal fissure and giant anal polyp. Archives of Dermatology 144(7): 950-952, 2008

Quality of patient information on the internet for the treatment of anal fistula and anal fissure. Techniques in Coloproctology 18(12): 1181-1183, 2015

Anal manometric evaluation in anal fissure. Effect of anal dilation and lateral subcutaneous sphincterotomy. Acta Chirurgica Scandinavica 152: 65-68, 1986

Hypertrophied anal papillae and fibrous anal polyps, should they be removed during anal fissure surgery?. World Journal of Gastroenterology 10(16): 2412-2414, 2004

Lateral sphincterotomy compared with anal advancement flap for chronic anal fissure. Diseases of the Colon and Rectum 38(1): 69-71, 1995

Functional outcome following lateral internal anal sphincterotomy for chronic anal fissure. Colorectal Disease 6(3): 210-211, 2004

Chronic anal fissure: morphometric analysis of the anal canal at 3.0 Tesla MR imaging. Abdominal Radiology 42(2): 423-434, 2016

Low energy manual anal stretch: an approach in the treatment of chronic anal fissure. Minerva Chirurgica 72(2): 103-107, 2016

Anal stretch for chronic anal fissure: an old operation that stood the test of time. Langenbeck's Archives of Surgery 2012, 2012