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Background: Chronic anal fissure is a common benign anorectal condition that causes significant morbidity. Symptoms consist primarily of pain and bleeding during defecation. Fissures are predominantly located in the posterior midline, but 25% of women and 8% of men have anterior fissures. Aims and Objectives: The aim of the study is to determine the outcome of various nonsurgical therapy for chronic anal fissure and comparison with the outcome of surgical treatment. Materials and Methods: This study was a non-randomized and observational study. All patients referred to the department of general surgery between December 2012 and November 2014 for a chronic anal fissure were included in the study, above the age of 12 years, and diagnosed to have anal fissure (Both Acute and Chronic) were included in the study. Results: Seventy-nine patients (91.9%) were having symptoms of pain; this pain was persistent for hours after defecation in 67 (78%) patients. Seventy-one (82.6%) patients complained of at least one episode of bleeding per Anum, other symptoms were perianal lump (10.5%), perianal itching (23.3%), and perianal discharge (30.2%). The examination findings of these patients revealed that 81 patients (94%) had developed sentinelpiles subsequently and anal fissure with visible fibers of underlying muscle were seen in 9 (10.5%) patients. Conclusion: Chronic anal fissures can be simply and effectively treated medically without the risk of incontinence associated with sphincterotomy. Topical nifedipine and botulinum toxin injections are an excellent combination, associated with a low recurrence rate and minimal side effects. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose Anal fissure is a common anorectal condition, yet its pathogenesis remains unclear. Lateral internal sphincterotomy (LIS) is the gold standard treatment for chronic anal fissures that do not respond to conservative treatment; however, it has a risk of anal incontinence. We believe that fibrosis of the internal anal sphincter is an important factor in the pathogenesis of chronic anal fissure. In this study, we describe the minimal LIS method, a minimally invasive method where only the fibrotic portion of the internal anal sphincter is cut. We also describe the outcomes of this method. Methods We performed a retrospective review of 468 patients (270 male and 198 female) who underwent minimal LIS for chronic anal fissure in 2017 at Seoul Song Do Hospital. We analyzed the patients’ clinical characteristics, manometry data, complications, and outcomes of minimal LIS. The outcomes of the surgery were assessed via questionnaires during the postoperative outpatient visits, beginning 2 weeks postoperatively. Results The overall complication rate was 4.0% (19 patients). Delayed healing occurred in 14 patients (3.0%), perianal abscess was present in 3 patients (0.6%), and gas incontinence occurred in 2 patients (0.4%). All complications were improved with conservative treatment. Recurrence, defined as the recurrence of anal fissure more than 4 weeks after healing, was present in 6 patients (1.3%). Conclusion Minimal LIS is a safe and effective treatment option for patients with chronic anal fissure. Postoperative complications, especially incontinence and recurrence, are rare.

A case study of 9-year-old girl is presented who was admitted due to a year-long history of recurrent presence of blood and mucus in the stool preceded with abdominal pain in lower abdominal quadrants. Topics include examines she had regular bowel movements, and the stools were of normal consistency and the patient was afebrile, well, and gaining weight steadily.

Background: Genital and anorectal Chlamydia trachomatis (CT) frequently present together in sexually transmitted infection (STI) clinics. Aim: To investigate the prevalence of co-occurrent genital and anorectal chlamydia infection, and to study whether sexual behaviour is associated with anorectal infection. Design & setting: A cross-sectional study in general practices in the north of the Netherlands. Method: Women attending general practice with an indication for genital chlamydia testing were included and asked to complete a structured questionnaire on sexual behaviour. Anorectal infection prevalence was compared according to testing indications: standard versus experimental (based on questionnaire answers). Variables associated with anorectal chlamydia were analysed by univariate and multivariate logistic regression analyses. Results: Data could be analysed for 497 of 515 women included. Overall, 17.8% (n = 87/490) were positive for CT; of these, 72.4% (n = 63/87) had co-occurrent genital and anorectal infection, 13.8% (n = 12/87) had genital infection only, and 12.6% (n = 11/87) had anorectal infection only. Rectal infection was missed in 69.3% of cases using the standard indication alone, while adding the sexual history still missed 20.0%. Age was the only variable significantly associated with anorectal infection. Conclusion: The prevalence of anorectal disease is high among women who visit their GP with an indication for genital CT testing. Many anorectal infections are missed despite taking comprehensive sexual histories, meaning that standard treatment of genital infection with azithromycin may result in rectal persistence. Performing anorectal testing in all women with an indication for genital CT testing is, therefore, recommended. [ABSTRACT FROM AUTHOR]

Background. Benign perianal disease carries significant morbidity and financial burden on the healthcare system. Given that sitz baths are recommended as a treatment modality, we considered whether using a continuous stream of water, in the form of a bidet, offers a convenient and effective alternative. Bidet use is the predominant form of perianal hygiene in Asia, but its role in perianal disease is unknown. Purpose. To critically analyze and systematically review the current evidence regarding the effect of habitual bidet use on symptoms of benign perianal disease. Data Sources. A database search was conducted on MEDLINE and Epub Ahead of Print, Embase, ClinicalTrials.gov, the Cochrane Library, and ProQuest Dissertations. All studies on bidet use in pruritus ani, hemorrhoids, or anal fissures were included. Data Extraction. The studies were screened and critically analyzed by two independent reviewers in line with PRISMA guidelines. Results. Two prospective trials and 1 cross-sectional study found that habitual use of bidets had no impact on the odds of developing hemorrhoids or hemorrhoidal symptoms. One RCT concluded that using bidets was non-inferior to sitz bath for post-hemorrhoidectomy pain. Two prospective trials and 1 cross-sectional study determined that habitual bidet use may increase the odds of developing pruritus ani. Two case series found that habitual bidet use may cause perianal burns or anterior anal fissures. A meta-analysis was not performed because only a limited number of studies were available, and they were of variable quality. Conclusion. The current evidence does not identify using bidets as a treatment modality for perianal disease, and further research is warranted to study this increasingly utilized technology. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Painful anal fissures could be distressing conditions that severely impair the patients' quality of life. The analgesic effectiveness of topical drugs, such as calcium-antagonists and nitrates is quite variable. The inhalational anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We report a pioneer experience treating a painful chronic anal fissure with topical sevoflurane. A young adult male was suffering from an extremely painful chronic anal fissure, which severely affected his quality of life. The topical treatment with nitroglycerine and diltiazem gels failed. The patient agreed to the treatement with topical sevoflurane as an off-label medication, and it produced an immediate, intense, and long-lasting analgesic effect. An intense but rapidly transient burning sensation, as well as persistent but well-tolerated flatulence were the only adverse effects. The quality of life was greatly improved, and the cost of the treatment was affordable. Therefore, the off-label use of topical sevoflurane appears to be an effective alternative for the symptomatic treatment of painful anal fissures.

Background: An anal fissure is a cut or split in the epithelial lining of the anal canal distal to the dentate line. Various topical ointments been described for its treatment. Aim and Objectives: To study Lignocaine (3%) with Zinc (5%) with Hydrocortisone (0.25%) combination (LZH) ointment in comparison to Lignocaine (4%) with Sucralfate (7%) with Metronidazole (1%) combination (LSM) ointment with respect to pain relief, healing, patient satisfaction and safety in acute fissure in ano (AFIA). Material and Methods: This was a prospective randomized study. Sixty patients with AFIA were randomly divided into two groups of 30 patients each. In group A LZH ointment and in group B LSM ointment was prescribed and followed up weekly for six weeks. Results: Our study shows less pain score in group B as compared to group A. The rate of healing was statistically significantly better in group B from 3rd week onwards. The patient satisfaction score was better in group B (P value = 0.0004). No complication was seen in any patient. Conclusion: Our study shows that the LSM ointment in comparison to LZH ointment is associated with early pain relief, better healing, better overall patient satisfaction, and equally safe in patients with AFIA

Purpose For the past several decades, internal anal sphincterotomy has generally been considered to be the standard operation for an anal fissure. However, wound complications inherent in this operation forced surgeons to look for an alternative form of treatment. The aim of our study was to evaluate the long-term outcome of anal dilatation for chronic anal fissure, especially possible negative impact on anal sphincter function. Methods The study was approved by the local Institutional Review Board and given a waiver of written consent. A phone call survey was undertaken among a group of consecutive patients who had an anal dilatation by standardized technique for chronic anal fissure for the period between 2000 and 2016. The survey included medical, obstetrical and surgical-related data, Wexner fecal incontinence score, recurrence of the anal fissure, and the need for additional medical intervention. Five hundred 48 patients were identified after limitations of age, concomitant pathology, and procedures that were applied to the hospital computerized database. Eighty-five patients (group A) agreed to participate in the survey and 463 patients did not. Results There were no differences between groups in demographic information and medical records data; therefore, group A may well represent a satisfactory sample of the whole group. The interval between the procedure and the survey was 6.8 ± 2.7 years. The Wexner incontinence score was 0 in 94% of patients. Conclusion Anal dilatation, performed in a systematic and standardized way, has a successful outcome with no complications and has no clear long-term negative impact on anal sphincter function.

Introduction: Despite the advent of new methods in the conservative treatment of Chronic Anal Fissure (CAF), such as nitric oxide donors, they often require surgical treatment. The gold standard surgical option for the CAF is Lateral Internal Sphincterotomy (LIS). This procedure usually involves dividing the Internal Anal Sphincter (IAS) from the distal end to the fissure or dentate line (whichever comes first). Aim: To evaluate the surgical outcome and complications of LIS in CAF. Materials and Methods: This cross-sectional descriptive study was conducted on 60 patients with CAFs who underwent LIS in Imam Reza Hospital, Tabriz, Iran. The study was approved by the Ethical Committee of Tabriz University of Medical Sciences and was done from February 2017 to March 2019. The following data were recorded: age, sex, history of constipation, constipation duration, history of prolonged diarrhoea, child birth history, type of delivery, history of receiving pharmacological treatment for fissure, history of past fissure surgery, postoperative pain, postoperative complications and recurrence rates. The results were analysed using statistical methods (mean±Standard Deviation (SD)) for quantitative variables and frequencies and percentages for categorical variables. Results: The mean age of the patients was 36.6±12 years (18- 70 years). During surgery, haemorrhoids, anal polyps, perianal fistulas, and anal masses were observed in 27 (45%), 7 (11.66%), 1 (1.6%), and 1 (1.6%) patients, respectively. After surgery, the patients’ symptoms decreased. Anal pain, bleeding and constipation decreased in 52 (86.67%), 50 (88.33%) and 43 (71.67%) patients respectively. Urinary retention, anal itching, and flatus incontinence were observed in 3 (5%), 1 (1.67%), and 9 (15%) patients, respectively. None of the patients had faecal incontinence and none had a recurrence. Complete healing was observed in all patients. Conclusion: The LIS is an effective and safe option in the surgical treatment of patients with anal fissure.

ObjectivesThe southeastern US is a domestic epicentre for incident HIV with high prevalence of herpes simplex virus (HSV) coinfection. We estimated the incidence rates (IR) of symptomatic herpetic anogenital ulcer disease (HAUD) and assessed its associations with demographic and clinical characteristics, specifically with immunological markers using median, nadir and trajectory CD4 counts.Methods: Electronic medical records (EMR) of over 7000 people living with HIV (PLWH) attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analysed. IR of HSV-related HAUD were estimated per 10 000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of IR. All IR and trends were stratified by gender and race. Six CD4 trajectory groups were constructed using the group-based trajectory modelling. Multivariable logistic models were conducted to assess the associations of CD4 counts (nadir, median CD4 and newly defined CD4 trajectory), separately with HAUD.Results: Of the 4484 PLWH eligible individuals (3429 men, 1031 women and 24 transgender), we observed 425 patients with HSV-related HAUD. The mean log10viral load was higher in HAUD than HAUD-free groups, whereas the median nadir CD4 count (cells/uL) was higher in the non-cases than the case groups (p<0.05). HAUD were more frequent in women than men. Median CD4 (<200 cell/uL) was associated with HAUD (OR=2.1), but there were no significant associations with nadir CD4. Significant associations with declining and sustained low CD4 counts trajectory patterns were observed with HAUD.Conclusions: There were significant differences between men and women with incident HAUD among PLWH. EMR-based studies can provide innovative trajectory models that can potentially be helpful in guiding screening and clinical care of HAUD among high-risk PLWH. [ABSTRACT FROM AUTHOR]

Ozone therapy delivered by local injections, together with topically applied ozonated vegetable oil, to a woman with chronic, extremely painful, and swollen anal fissure provided rapid relief of symptoms. All symptoms were abated by 14 sessions. Full healing occurred, which to date has endured over 2 years. Ozone by injection may be a superior form of delivery of this healing gas than rectal insufflation for anal fissure. The treatment is inexpensive, relatively non-invasive, and can be performed without pain under local anesthesia. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis (CT) can infect the anorectum producing various signs and symptoms. There is scarce literature regarding the differences between LGV and non-LGV CT anorectal manifestations. We compare the clinical spectrum of LGV and non-LGV infections. Methods: Patients over 18 years with presumptive infectious anorectal symptoms were examined in two healthcare centres in Buenos Aires. The patients were studied and treated according to current sexually transmitted infection guidelines. Anorectal swabs were collected to detect and genotype CT. Results: A three-year-long study on 317 patients with anorectal symptoms showed 45.11% CT infection (85% LGV strains). Of 140 samples, 92 were sequenced: 80/119 LGV (L2b 45%, L1 32.5% and L2 22.5%) and 12/21 non-LGV. Older age and HIV+ status were significantly higher in the LGV group. Anal discharge, bleeding, severe proctitis and anal ulcers were more common in the LGV group. Multivariate logistic regression analysis revealed that HIV infection, anorectal bleeding and oro-anal sex are independent predictors of LGV infection. Conclusions: In patients with anorectal symptoms, LGV serovars predominate over non-LGV ones. Clinical manifestations are not pathognomonic of a specific biovar. If genotyping is not available, having clinical predictors may help to presume an LGV infection and define length of treatment. [ABSTRACT FROM AUTHOR]

Introduction: An anal fissure is defined as a split in the mucosa extending from the anal verge towards the dentate line and most common proctologic symptom. The management of anal fissures is diverse and range from non-operative techniques like dietary changes, topical ointments (2% diltiazem, 0.2% glyceryl trinitrate), botulinum toxin injections and sitz baths to surgical intervention. Aim: To evaluate and compare the efficiency of Topical Glycerine Nitrate (0.2%) with Topical Diltiazem (2%) in patients with anal fissures. Materials and Methods: Out of 100 patients of anal fissure, 50 were selected for treatment with topical application of 2% Diltiazem and were classified as Group I while rest 50 selected for topical application of 0.2% Glyceryl trinitrate and were classified as Group II. Patients were followed for a period of six weeks (weekly follow-up) to evaluate the healing effect of above two topical ointments. Results: On follow-up at week six, patients relieved of all the complaints were assessed as fully cured and patients still having any of the complaints were assessed as partially cured. Full cure was observed in significantly higher proportion of cases of Group I as compared to Group II (88.0% vs. 68.0%), rest of the patients of both the groups had partial cure. Majority of the patients of both the groups did not observe any side effects (Group I-94.0% and Group II-84.0%), remaining patients of Group I reported side effects of Itching (6.0%) while remaining patients of Group II reported headache as side effect (16.0%). Difference in side effects of patients of above two groups was found statistically significant. Conclusion: Findings of the present study indicated that topical diltiazem (2%) was more effective as compared to glyceryl trinitrate (0.2%) for conservative treatment of anal fissure. Diltiazem was capable to provide full relief of complaints within six weeks to majority of the cases (88.0%).

Rectal bleeding is a common symptom experienced by pregnant women. Although the majority of cases are attributable to benign conditions such as haemorrhoids and anal fissures, other more serious diagnoses such as inflammatory bowel disease and malignancy should not be overlooked. Most investigations are safe during pregnancy and these should not be withheld as significant implications on both fetal and maternal morbidity may result. In these cases, a multidisciplinary team approach is essential. This review explores the differential diagnosis, investigation and management of rectal bleeding during pregnancy. [ABSTRACT FROM AUTHOR]

In the treatment of chronic anal fissure, both surgical and topical treatment methods are used. The purpose of this study was to research a combined topical treatment that we prepared and to compare the effectiveness of lateral internal sphincterotomy in chronic anal fissure with this topical treatment. A total of 183 patients with chronic anal fissure were divided into two groups. One hundred and four patients had topical medical treatment (group 1) and seventy-nine patients underwent lateral internal sphincterotomy (group 2). In the first group, a topical combination of ointments consisting of bacitracin-neomycin sulfate, dexpanthenol, and diltiazem was applied to the anal area. Four weeks after treatment, pain and bleeding during defecation, gas/fecal incontinence, treatment-related adverse events and recovery rates were evaluated in both groups. Also, patients were examined for recurrence between the 8th and 10th weeks. There was no significant difference in recovery rates between the groups. In group 1, recovery rate was 82.7%, while in Group 2 it was 92.4% (p = 0.054). In both groups, gas/fecal incontinence ratio was significantly different, supporting the medical treatment (p = 0.02). The severity of pain and bleeding during defecation were compared between the groups. Only the severe pain was significantly higher in the medical treatment group (p = 0.018). The recurrence rate was 5.8% in the medical treatment group, but no recurrence was detected in the surgical group. Due to possible complications of surgical treatment and similar recovery rates, medical treatment of patients with chronic anal fissure can be tried before surgical treatment. [ABSTRACT FROM AUTHOR]

Background: An anal fissure is a cut or split in the epithelial lining of the anal canal distal to the dentate line. Various topical ointments been described for its treatment. Aim and Objectives: To study Lignocaine (3%) with Zinc (5%) with Hydrocortisone (0.25%) combination (LZH) ointment in comparison to Lignocaine (4%) with Sucralfate (7%) with Metronidazole (1%) combination (LSM) ointment with respect to pain relief, healing, patient satisfaction and safety in Acute Fissure In Ano (AFIA). Material and Methods: This was a prospective randomized study. Sixty patients with AFIA were randomly divided into two groups of 30 patients each. In group A, LZH ointment and in group B, LSM ointment was prescribed and followed up weekly for six weeks. Results: Our study shows less pain score in group B as compared to group A. The rate of healing was statistically significantly better in group B from 3rd week onwards. The patient satisfaction score was better in group B (P value = 0.0004). No complication was seen in any patient. Conclusion: Our study shows that the LSM ointment in comparison to LZH ointment is associated with early pain relief, better healing, better overall patient satisfaction, and equally safe in patients with AFIA. [ABSTRACT FROM AUTHOR]

Milligan-Morgan haemorrhoidectomy (MMH) is still regarded as the standard excisional haemorrhoid procedure. In our centre, prophylactic lateral internal sphincterotomy (LIS) has been routinely performed simultaneously with MMH due to increased incidence of concurrent chronic anal fissure (CAF). We aimed to review our practice, the safety and feasibility of routine MMH+LIS among patients with or without CAF. A prospective observational study was conducted to examine the outcome of MMH + LIS in Kassala, Sudan, from 2015 to 2018. The short-term outcomes of patients undergoing MMH+LIS were compared between patients with or without CAF. There were 252 patients included in the study, with the median age of 33 (ranged 13–80), and 146 (57.94%) were male patients. Of these, 205 patients (81.3%) had third-degree prolapsed haemorrhoids, and 47 patients (18.7%) had fourth-degree prolapsed haemorrhoids, with 73 (29%) patients had a concurrent chronic anal fissure. There were no significant difference (p > 0.05) between the comparing groups with regard to the complications occurred, which were post-operative bleeding (n = 4, 1.6%), anal stenosis (n = 5, 1.98%), faecal incontinence (n = 2, 0.79%), chronic anal pain (n = 5, 1.98%), chronic anal discharge (n = 3, 1.19%), pruritus ani (n = 4, 1.58%) and obstructed defaecation symptoms (n = 4, 1.58%). The overall complication rates were 16/252 (6.3%). Patients without pre-existing CAF were significantly associated with increased post-operative pain (p < 0.0001) after LIS. Prophylactic LIS, along with MMH, is a safe strategy with reasonable desired short-term outcomes and low complication rates. Patients with pre-existing CAF gain better pain control having had concurrent LIS which ultimately justify the procedure. [ABSTRACT FROM AUTHOR]

Background: One of the most frequent causes of anal discomfort and pain is fissure in ano in which there is a linear tear in the squamous epithelium that lines the anal canal at location distal to dentate line. The disease is encountered in both male and female gender and no age is immune particularly middle age and young age. Little is known about the prevalence rate and clinical presentation in our community of Al-Diwaniyah Province, Iraq. Aim of the Study: The current study was aiming at identifying the prevalence and clinical Presentation of Fissure-in-Ano in a Private Surgical Clinic in Al-Diwaniyah Province, Iraq. Patients and Method: The current cross sectional study was carried out at a private surgical clinic in Al- Diwaniyah Province, Iraq. The study duration extended from January the 2nd 2019 to December the 31st 2019.During this period patients with an age between 20-60 years were enrolled based on their clinical presentation of an anorectal problem. Any patient with previous anal surgery, with malignant disorder, pregnancy or lactation was excluded from the study. All enrolled patients were examined by digital rectal examination and proctoscopic examination. Sigmoidoscopy and colonoscopy were done as required. Result: The study included a total of 314 patients with anorectal complaint of whom 78 patients had fissure in ano making the prevalence rate as 24.8 %. Those patients with anal fissure were categorized into 57 (73.1%) males and 21 (26.9%) females. Most patients were between 31-40 years of age and the mean age of all patients was 34.98±7.81 years and the range was 20-60 years. Most of fissures were located in the posterior midline location and the minority of them was seen in an anterior midline location. The majority of patients had acute disease and the minority of them had chronic disease with some having sentinel pile. Conclusion: It has been shown therefore, that anal fissure is a common problem in our community and that young age and middle age men are the target of majority of cases. The clinical features vary according to age and gender [ABSTRACT FROM AUTHOR]

Anal Fissure is one of the major causes for pain at anal region. In this case report we are presenting case of 32 year old male patient came to OPD of Shalya tantra with the chief complains of pain during defection since 20days, itching at perianal region since 15 days and bleeding per rectum since 13 days. InterventionIn this case report patient is treated by using Go ghrita for the management of acute fissure in ano. Go ghrita was used for local application along with sitz bath.The effectiveness of Go ghrita was assessed by pain bleeding itching and healing. The patient has found effective relief from pain, bleeding, itching at perianal region using Go ghrita which has anti-inflammatory activity, antiulcer activity. The outcome of this management is that Go ghrita is effective in the management of Fissure in ano . Patients who take all followup after treatment will have less chance of symptom reoccurrence. [ABSTRACT FROM AUTHOR]

Deep soft tissue infections are an important cause of morbidity and mortality in immunosuppressed patients especially receiving chemotherapy. It is draw attention to the need to provide education on this subject to pediatric patients and their families. 16 years old, male patient diagnosed with acute myeloblastic leukemia and under intensive chemotherapy; he had severe pain and bleeding during defecation. There was an ulcerated lesion in the anal region. There is an anal fissure laceration at the six and twelve o'clock positions. Other examinations are normal. F: 37.6 0C, Pulse: 164/min, 24/min BP: 110/60 mmHg. Wbc: 300 mm3 Hb: 8.7 g/d L Hct: 26% plt: 12000 mm3 CRP: 80mg/L procalcitonin: 52.3µL Biochemical parameters are normal. Deep soft tissue infection was considered in the patient. Since the anal area is a moist, closed environment where the patient is located, infections in this area can progress very quickly without the patient noticing. The patient was evaluated as having febrile neutropenia. As treatment; Teicoplanin, meropenem and metronidazole were started as treatment. Due to low hemoglobin and platelet count, erythrocyte and platelet suspension replacements were performed. As a result of 3 weeks of treatment, ulcer lesions in the anal area improved. The patient and his family were given anal and genital area care training. The patient has recovery and he was started on outpatient follow-up and treatment. This case report may provide a resource for the planning and implementation of correct medical treatment interventions for the patient and his family who have difficulty in managing soft tissue infections. [ABSTRACT FROM AUTHOR]