The swelling that localized on distal of dentate line and covered by anoderm
was diagnosed as external hemorrhoid.
It is a longitudinal rupture of the stratified squamous epithelial tissue formed in the anoderm
distal to the dentate line and is generally located on the middle line posterior to the anus (2, 3).
, vagina, and perineal skin were sutured with absorbable materials.
It is due to use of high concentration of GTN (0.3%) vs (0.2%) and applied to the anoderm
three times per day compared to 2 times.
Acute fissures have the appearance of a simple tear in the anoderm
, while the chronicity of fissures is determined by the presence of symptoms (pain on defecation, bleeding per rectum) lasting for more than six weeks, and along with classical triad of fissure with sentinel skin tag, and hypertrophied anal papilla.4-6 Fissures are predominantly located in the posterior midline, but 25% of females and 8% of males have anterior fissures.
It is characterised by wet mucosa of the vestibule anteriorly and a dry anoderm
posteriorly at the junction of the vestibule and perineum, classic appearance of a girl with a cloacal malformation with a single perineal orifice.
The most common cause of an anal stricture is iatrogenic, from excision of anoderm
during surgery for hemorrhoids, anal warts, or fistulae-in-ano [2, 4].
With the anoscope inserted, using the technique described above, multiple running sutures were placed above the dentate line, in order to avoid the anoderm
and tied at the proximal end of the hemorrhoid (Figure 4).
Anal fissure is a superficial linear tear in the anoderm
, most commonly caused by passage of a large, hard stool.1 This tear is distal to the dentate line.
The procedure involves dissecting the sphincter complex from the surrounding anoderm
, then overlapping the edges of the sphincter muscle and suturing them together.
Any superimposed insult to the anoderm
by a hard fecalith in a patient with chronic fissure-in-ano leads to the development of acute-on-chronic fissure-in-ano (2).
Anal fissure is probably secondary to overstretching of the anoderm
during the passage of a large or hard stool.