Chronic Anal Fissure

Chronic anal fissure presents as longitudinal, deep ulcer, sometimes coated with smear. Secondary changes can occur in their development, such as hypertrophied anal papillae close to the proximal edge of the fissure at the level of the pectinate line, also pathologically altered crypts (anal cryptitis) or sentinel tags (secondary skin tags) with or without incomplete or complete fistula. At this stage, the wound edges are scarred and bulging, occasionally callused or undermined. Sometimes, the transversely running, now and then fibrous tissue of the internal anal sphincter appears at the fissure floor. It is not the duration of the existence of the anal fissure that is pathognomonic for the chronic anal fissure, but the appearance of the alterations mentioned earlier. The difficulty of a morphologically related definition of the chronic anal fissure is dealt with in Chap. 4.