A 42-year-old female presents with severe pain on defecation and bright red blood on toilet tissue for 4 weeks. Examination of the anal verge reveals an exquisitely tender linear tear in the posterior midline of the anoderm. What is the diagnosis?
Answer and explanation
Correct answer: D. Acute anal fissure
- Step 1: A linear tear in the anoderm distal to the dentate line in the posterior midline is an anal fissure.
- Step 2: It presents classically with severe tearing pain during defecation accompanied by bright red rectal spotting.
Answer
Acute anal fissure.
Why not the others: 'External thrombosed hemorrhoid' presents as a painful, tense, purplish perianal subcutaneous nodule; 'Perianal abscess' presents with a fluctuant, erythematous, indurated perianal mass with throbbing pain and fever; 'Anorectal fistula' features chronic purulent or serosanguinous drainage from a secondary skin opening.
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