RESUMEN
A 46-year-old male presented with features of anemia. On evaluation, there was iron deficiency. No source of bleeding could be located by upper and lower gastrointestinal endoscopy. Computed tomography (CT) scan and Mantoux test had evidence of tuberculosis. He deteriorated with antitubercular therapy. He improved only after laparotomy, a diagnostic laparoscopy and resection of the bleeding malignant lesion. It turned out to be jejunal cancer. Seven years after chemotherapy, he is surviving disease free. In undiagnosed iron-deficiency anemia, small bowel growth should be considered and diagnostic laparoscopy should be done to avoid confusion in diagnosis.
RESUMEN
Background: Standard treatment for Chronic Anal Fissure (CAF) is unilateral Internal Sphincterotomy (UIS). Still there is recurrence and the risk of of incontinence. Bilateral Internal Sphincterotomy (BIS) as a treatment for CAF has not been adequately evaluated. Methods: A prospective randomized controlled trial of UIS at 3 o clock compared with BIS at 3 and 9 ‘O’ clocks. The outcome variables were : post operative pain, recurrence and incontinence. Result: There was 104 and 107 cases in UIS and BIS group respectively with similar age and sex. There were 12 recurrences in UIS and only one in the BIS group (p< 0.001) with no change in the continence. BIS group had less pain (p<0.001). Conclusion: BIS for CAF resulted in less postoperative pain, lower recurrence with no increase in the incontinence. However, further study is required with pre and post operative anal manometry.