A 47-year old female presented with a purulent discharge per anum for 14 months. During examination under anaesthesia a ‘sinus’ was found extending from six o’clock position at dentate line into the post-anal space. The primary opening was at the upper end of a fissure-in-ano (Figure 1). She underwent exploration of the post-anal space where a partially destroyed coccyx was found in an ‘abscess...

Epidemiological features of proctological disease are not well known because available studies have provided variable conclusions. Risk factors frequently mentioned include heredity, high socioeconomic level, obesity, smoking, a diet rich in fats, alcohol, spices and pepper as well low fluid intake have all been implicated. While treating patients with various ano-rectal pathologies, apart from...

An acute fissure when observed by everting the anus *shows longitudinal muscle fibres in the floor of the ulcer. These are fibres of the conjoint longitudinal muscle layer which have passed downwards through the internal anal sphincter to gain attachment to the anal canal and perianal skin. If the lesion persists, the longitudinal fibres ulcerate through to expose the underlying whitish circula...