Match each clinical presentation of anorectal disease with the most appropriate definitive surgical or procedural management.
- A 35-year-old man with severe, tearing pain during defecation and a visible sentinel skin tag; symptoms have persisted for 8 weeks despite sitz baths and topical nifedipine.Lateral internal sphincterotomy
- A 42-year-old woman with Crohn disease who presents with a chronically draining perineal opening that traverses a significant portion of the external anal sphincter.Placement of a draining non-cutting seton
- A 28-year-old man with a 3-day history of severe, constant, throbbing perianal pain and a tender, fluctuant, erythematous mass near the anal verge.Immediate incision and drainage
- A 55-year-old man with painless bright red blood per rectum and anal tissue that prolapses during bowel movements, which he must manually reduce.Rubber band ligation or excisional hemorrhoidectomy
Answer
Refractory anal fissure matches with lateral internal sphincterotomy; complex Crohn fistula matches with seton placement; perianal abscess matches with incision and drainage; Grade III internal hemorrhoids matches with rubber band ligation/excision.
Each selected surgical procedure directly addresses the underlying pathophysiology of the specific anorectal condition while minimizing severe complications (e.g., preserving sphincter tone in complex fistulas by avoiding fistulotomy).
Step-by-Step Solution
Key Concept
Surgical indications and procedural selection for common anorectal disorders
Estimated Time:1m 30s