Aspects Cliniques et Endoscopiques des Fissures Anales dans deux Sites D’endoscopie Digestive de Kayes (Mali)

RESUME Introduction. Le but de notre etude etait de decrire les aspects cliniques et endoscopiques de la fissure anale a Kayes au Mali. Methodes. Il s’agit d’une etude transversale retrospective, menee du 1er Mars 2017 au 31 Octobre 2018. Elle a porte sur l’analyse des comptes rendus d’anorectoscopie dans les unites d’endoscopie digestive de l’Hopital regional Fousseyni DAOU de Kayes et de la clinique medicale « SEWA » de Kayes. Les donnees ont ete recueillies a partir des registres d’anorectoscopie. Les renseignements pour chaque patient ayant la fissure anale comme diagnostic retenu etaient l’âge, le sexe, la profession, la residence, l’indication et les resultats de l’endoscopie. Resultats. Durant la periode d’etude, 402 patients ont beneficie d’examen anorectoscopique. La fissure anale a ete diagnostiquee chez 134 patients soit une frequence de 33,33 %. L’âge moyen des patients etait de 36,5 ans avec des extremes de 16 et 76 ans et le sex-ratio etait de 2,6. La proctalgie (59%) et la rectorragie (38,1%) etaient les indications d’anorectoscopie les plus frequentes. En position genu-pectorale, la fissure anale etait posterieure (85, 1%), anterieure (10,4%), bipolaire (3%) et laterale (1,5%). La fissure anale chronique representait 79,1% des cas. Dans 18% des cas, la fissure anale etait associee a d’autres pathologies proctologiques. La maladie hemorroidaire a ete la pathologie la plus frequemment associee (91,7 %) des cas. Conclusion. La fissure anale atteint l’adulte jeune de sexe masculin. Son evolution est en regle chronique et la localisation posterieure. ABSTRACT Objective. To report the clinical and endoscopic features of anal fissure in Kayes City, Mali. Methods. This was a cross sectional descriptive retrospective study, conducted from March 1st, 2017 to October 31 st, 2018 in the digestive endoscopy units of the Fousseyni Daou Regional Hospital in Kayes and the SEWA Medical Clinic of Kayes. Data were collected from the anorectoscopy registers. We recruited all patients with an endoscopic diagnosis of anal fissure. Our study data were: age, sex, occupation, residency, indication of endoscopy and endoscopic findings related to the fissure. Results. During the study period, 402 patients had an anorectoscopic examination. Anal fissure was diagnosed in 134 of them (33.33%). The average age of the patients was 36.5 years (range: 16 - 76 ) and the sex ratio was 2.6. Proctalgia fugax (59%) and hematochezia (38.1%) were the most frequent indications of endoscopy. In knee-pectoral position, anal fissure was posterior (85, 1%), anterior (10.4%), bipolar (3%), and lateral (1.5%). Features of chronic fissure were present in 79.1% of cases. Associated proctologic diseases were found in 18% of patients, among which hemorrhoid disease was the most common (91.7%). Conclusion. Anal fissure affects mainly young males. The course is usually chronic and the localization is most often posterior.