Dr. Vaishali Chand (General Surgery) needs a second opinion on this medical case.
33 y.o. Female patient presented with a 9 year history of complaints of bouts of diarrhea, sometimes with or without right sided abdominal pain. Diarrhea so severe that pt has has 2 thrombosed hemorrhoids removed in the past, multiple incidences on anal fissures with bleeding, and this that has been present for about 2 years, often it causes no symptoms, but at the current time it is causing pain. Patient was referred to GI, given lomotil for diarrhea and viscous lidocaine to apply topically. Is this a Chronic fissure or a fistula? What would be your recommendations?