Hépato-Gastro & Oncologie Digestive
MENUDouleurs proctologiques aiguës Volume 18, issue 2, Mars-Avril 2011
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- Key words: anal pain, anal abscess, haemorrhoid thrombosis, anal fissure
- DOI : 10.1684/hpg.2011.0557
- Page(s) : 156-65
- Published in: 2011
Anal pain is a symptom commonly reported during consultation for ano-rectal disease. It is a non-specific symptom, associated with both emergency and chronic pathologies, and with both benign and serious conditions. Suppurations must be rapidly identified. They require an emergency treatment because spontaneous evolution is potentially severe. But aetiological diagnosis is not always easily established during initial visit. In a patient without significant past medical history, when no sign of severe problem is present, and when clinical examination is normal, a second visit can help establishing diagnosis. When an abscess is suspected, antibiotherapy will not cure the patient, and may expose to occurrence of septic complications. When immediate intervention for an abscess is not possible, incision will control pain and infection for a few days. Haemorrhoidal thrombosis is another frequent aetiology of acute pain. Diagnosis is not difficult, and when appropriate medical treatment does not alleviate pain, incision under local anaesthesia is indicated. Pain associated with anal fissure is typically ryhthmed by stool passage. For non-healing fissures, surgery may be proposed. Fecaloma, trauma, herpes virus infection and foreign body are less frequent, and clinical context is often suggestive.