Abstract
Anal fissure is a disruption of the skin at the distal anal canal. Most anal fissures are located in the posterior midline, with 10% to 15% occurring anteriorly. “Off the midline” fissures must be viewed with suspicion for underlying pathology such as Crohn's disease, HIV/AIDS, tuberculosis, syphilis, or anal carcinoma. Early fissures have the appearance of a simple tear in the anoderm. With the passage of time, chronic fissures develop thickened skin margins, and fibers of the internal anal sphincter (IAS) become visible at the fissure's base. Many patients with chronic fissures develop a sentinel skin tag at the distal fissure margin and a hypertrophied anal papilla just proximal to the fissure within the anal canal.GASTROENTEROLOGY 2003;124:235-245
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