Anal Fissür
Özet
Anal fissür (AF), anal kanalda oluşan lineer yırtıklar olarak tanımlanır ve proktolojik başvuruların önemli bir kısmını oluşturur. Akut fissürler genellikle yüzeyel olup kabızlık gibi geçici nedenlerle gelişirken, 6-8 haftayı aşan vakalar kronik anal fissür (KAF) kategorisine girer. Etyopatogenezinde iç anal sfinkter hipertonisitesi ve buna bağlı gelişen lokal iskemi temel rol oynar. Hastalar tipik olarak dışkılama sırasında şiddetli ağrı ve parlak kırmızı kanama şikayetiyle başvururlar. Tanı genellikle fizik muayene ile konulurken, atipik yerleşimli fissürler Crohn hastalığı veya enfeksiyonlar gibi altta yatan diğer nedenler açısından araştırılmalıdır. Tedavi yaklaşımı konservatif yöntemlerden cerrahi müdahaleye kadar geniş bir yelpazeyi kapsar. Akut vakalarda sıcak oturma banyosu, diyet düzenlemeleri ve topikal kremler %87 oranında iyileşme sağlarken, kronik vakalarda bu oran düşer. Farmakolojik tedavilerde nitratlar, kalsiyum kanal blokerleri ve botulinum toksini sfinkter basıncını azaltmak amacıyla kullanılır. Konservatif tedaviye dirençli kronik fissürlerde "altın standart" kabul edilen yöntem lateral internal sfinkterotomidir (LİS). Alternatif olarak fissürektomi, flep ilerletme ve sakral sinir stimülasyonu gibi yeni yaklaşımlar da mevcuttur. Tedavi seçiminde hastanın yaşam kalitesi ve potansiyel inkontinans riski mutlaka göz önünde bulundurulmalıdır.
Anal fissure (AF) is defined as linear tears in the anal canal and accounts for a significant portion of proctological consultations, appearing as acute lesions often caused by constipation or as chronic anal fissure (CAF) when lasting more than 6-8 weeks. The pathogenesis primarily involves internal anal sphincter hypertonicity and resulting local ischemia, leading to symptoms of severe pain during defecation and bright red bleeding. Diagnosis is usually established through physical examination, though atypical fissures require investigation for underlying conditions like Crohn's disease or infections. Treatment ranges from conservative measures, such as warm sitz baths, dietary changes, and topical ointments—which heal 87% of acute cases—to pharmacological options like nitrates, calcium channel blockers, and botulinum toxin aimed at reducing sphincter pressure. For chronic fissures resistant to conservative therapy, lateral internal sphincterotomy (LIS) remains the "gold standard," although alternative approaches such as fissurectomy, advancement flaps, and sacral nerve stimulation are also available. Ultimately, treatment selection must evaluate the patient's quality of life against the potential risk of incontinence.
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