Management of idiopathic ulcer of the anal canal by excision in HIV-positive patients.

Abstract

The aim of this article is to show our results from the surgical treatment of idiopathic anal ulcers. We present 33 patients with acquired immunodeficiency syndrome and idiopathic perianal ulcers. They presented with anal pain that failed to improve with medical treatment. Evaluation under anesthesia typically showed an irregular ulcer in the anal canal and an intersphincteric abscess. Surgical treatment consisted of an incision around the ulcer, its excision including margins but not its base, and abscess drainage. All patients experienced significant immediate postoperative pain relief. Biopsies of the ulcer showed chronic inflammation, and no specific agents appeared in cultures. These lesions seem to have the same cryptogenic origin as perianal abscesses, and we recommend surgical treatment to provide symptom relief.