Abstract

Title

Clinical spectrum of patients with Perianal diseases in a Tertiary Care Center in Northern India

Introduction

Perianal diseases are one of most common presenting ailments in outpatient department, like haemorrhoids, fissures, fistulas, or abscesses that affect the anal region. In their lifetime, most people experience some form of anorectal disorder. There is scarce data on the overall incidences of perianal diseases from India. Most researches become specific disease-centric [1] and do not do justice to the magnitude at which Perianal diseases affect the population as a whole. My project strives to add to that epidemiological pool through an observational, cross-sectional study with simple random sampling from the patients who presented to the Surgery OPD of Dayanand Medical College, Ludhiana.

Aims and objectives

• To study the clinical spectrum of Perianal diseases and study their relation to the demographic variables
• To classify the disorders and find out which is most common presenting type.
• To identify the etiological factors associated.
• To determine the most common presenting symptom.
• To identify any co-morbid conditions and associated diseases (like inflammatory bowel disease)

Methodology

A total number of 82 patients presenting with perianal symptoms in the Surgery OPD of Dayanand Medical College and Hospital, Ludhiana were randomly selected enrolled for the study conducted over two months and were informed about the aims and objectives of the study and were required to sign an informed consent prior to inclusion in the study. The demographic data, brief history, associated chronic diseases, results of examination and investigations, classification of diseases and management advised by doctor were noted down. The data collected was analyzed.

Result and Conclusions

• Perianal disease presented chiefly as hemorrhoids (50%), fissures (33%) and fistula/abscess (27%).
• Majority of patients were from age group 30-50 years (53.66%) with male predominance (69.51%).
• The common presenting symptoms were pain (72%), bleeding (53%), perianal swelling, discharge, pruritis, mass from/in anus and fever, in that order. 
• Most of the cases required proctoscopy (74%) as an investigation. Fistulogram was needed in 11% of cases out of overall. Few patients required additional investigations.
• Grade 2 internal hemorrhoids were present in 44%, followed by internal grade 1 (31%), internal grade 3 and external both having (12% patients each) and internal grade 4 hemorrhoids (2%).
• 88% had acute and 12% had chronic fissures.
• 30% had intersphincteric, 21% had subcutaneous and 9% had transsphincteric fistula/abcess but maximum cases were unclassified (39%).
• Majority of the patients were adequately treated with conservative management (70%) and only 30% needed surgical intervention. This trend was followed by hemorrhoids and anal fissures, but fistula/abcesses were mainly managed surgically.
• Constipation was found in 72% patients overall and also in majority of haemorrhoids and anal fissure cases.
• Diabetes mellitus (10%) and hypothyroidism (5%) were most common associated chronic diseases.