Epidemiological, Clinical, and Therapeutic Aspects of Anal Fissures in the Hepatology and Gastroenterology Department of Gabriel Touré University Hospital

Abstract

Introduction: An anal fissure is an acquired and independent condition defined as a loss of substance in the epithelium and dermis of the distal part of the anal canal, located at the level of a commissure of the anal margin. It is the second most frequent proctological pathology after hemorrhoidal disease. Objective: To study the epidemiological, clinical, and therapeutic aspects of anal fissures in the Hepatogastroenterology department. Methods: This was a descriptive prospective study conducted in the Hepatogastroenterology department from October 2021 to November 2022, including patients seen in consultation for anal fissures. Results: We identified 77 patients with anal fissures, 47 men and 30 women (male-to-female ratio = 1.57), with a mean age of 35.44 ± 14.37 years (range 17–84 years). Constipation was the predominant medical history, accounting for 97.4% of cases. Of the 77 patients, the anal fissure was recent in 57.1%, long-standing in 42.9%, and infected in 10.3%. In the clinical presentation, anal pain was the most common symptom, followed by constipation, rectal bleeding, and anal pruritus in 97.4%, 77.9%, and 33.7% of cases, respectively. The anal fissure was located at the posterior commissure in 75.3% of cases. A single anal fissure was present in 92.2% of our patients. Associated lesions were primarily hemorrhoidal disease (53.2%), polyps (1.3%), and fistulas (1.3%). Treatment was medical in 71.4% of cases, instrumental in 27.2%, and surgical (fissureectomy) in 1.3%. The recurrence rate was 8% after medical treatment and 12.5% after instrumental treatment. Conclusion: Anal fissure is a fairly common pathology with a predilection for young adult males in the Hepatology-Gastroenterology department. Its diagnosis is purely clinical and medical treatment retains its place in the therapeutic arsenal.