12-15-2007, 02:02 AM
A 26-year-old male presents with persistent perianal pain for 2 months that is worse with
defecation. The patient notes that he occasionally sees small amounts of red blood on the toilet
tissue. He never has had blood staining the toilet bowl. He reports persistent constipation but
has not had any incontinence. He denies anal trauma. On physical examination there is a linear ulceration with raised edges with a skin tag at the distal end. Circular fibers of the
hypertrophied internal sphincter are visible. What is the most appropriate treatment of this
disease?
A. Sitz baths
B. Placement of a mechanical loop followed by surgical resection
C. Steroid enemas
D. Nitroglycerin ointment
E. Mesalamine enemas
defecation. The patient notes that he occasionally sees small amounts of red blood on the toilet
tissue. He never has had blood staining the toilet bowl. He reports persistent constipation but
has not had any incontinence. He denies anal trauma. On physical examination there is a linear ulceration with raised edges with a skin tag at the distal end. Circular fibers of the
hypertrophied internal sphincter are visible. What is the most appropriate treatment of this
disease?
A. Sitz baths
B. Placement of a mechanical loop followed by surgical resection
C. Steroid enemas
D. Nitroglycerin ointment
E. Mesalamine enemas