Abstract
Background: Chronic anal fissure is a common painful benign anorectal case. Surgical operations like lateral internal sphincterotomy or manual anal dilatation are effective for healing most cases within a few weeks. However, as a side effect, permanent impaired anal .continence is likely to occur Aim: This article aims to evaluate whether the pharmacological can be the first-line option for .the treatment of chronic anal fissure Patients and Methods: 60 patients are enrolled with a chronic anal fissure in this work. The cases were chosen randomly from Kirkuk general hospital during the period from February 2017 to October 2018. As a first-line therapy, all patients treated with diltiazem 2% cream for .6 weeks Results: As a result of adverse drug reaction and uncooperative patients, 10 patients were unable to complete medical treatment, while 50 patients were able to complete it. Furthermore, 40 patients (out of 50) achieved complete recovery with 25 males and 15 females. Nevertheless, 10 patients (7 males and 3 females) were failed to reach complete recovery, which makes undergoing sphincterotomy as a second-line option. Complete recovery is achieved in (n=45) 90% of patients within 5-6 weeks from the start of diltiazem 2% cream. Whereas, 10% of them (n=5) recovered with complete 6 weeks administration of .the cream Conclusions: For majority patients with a chronic anal fissure, diltiazem 2% cream with a course of six weeks was the first-line choice therapy.
Highlights
Chronic anal fissure is defined as an ulcer of the anoderm
Evaluations were carried on patient status regarding pain, bleeding, anal tone and fissure healing in every weekend to observe the patient response to medical treatment
Pain was present in the all patients with anal fissure while bleeding account for (n= 15, 19.73%) in males and (n=7, 15.90%) in females. (n=19, 24.34%) of males and (n=12, 26.13%)of females patients had sentinel skin tag, (n=6, 7.89%) of males and (n=3, 7.95%) of females had hypertrophied anal papillae, and about (n=3, 4.60%) males,(n=1, 3.40%) females had combined or other type (n=10, 13.15% males, n= 6, 12.5% females) of anal fissure
Summary
Chronic anal fissure is defined as an ulcer of the anoderm. Distal to the dentate line, typically, it occurs in the midline (whether anterior or posterior) with visible sphincter fibers, anal papillae, sentinel piles and indurated margins [1]. With more than 6 weeks of symptoms, a chronic fissure is usually deeper and generally has exposed internal sphincter fibers in its base [5]. Based on etiology, it is classified as primary (idiopathic) or secondary. 10 patients (7 males and 3 females) were failed to reach complete recovery, which makes undergoing sphincterotomy as a second-line option. 10% of them (n=5) recovered with complete 6 weeks administration of .the cream Conclusions: For majority patients with a chronic anal fissure, diltiazem 2% cream with a course of six weeks was the first-line choice therapy
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