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

PURPOSE. The aim of this article is to show our results from the surgical t reatment of idiopathic anal ulcers. METHODS: We present 33 patients with ac quired immunodeficiency syndrome and idiopathic perianal ulcers. They prese nted with anal pain that failed to improve with medical treatment. Evaluati on under anesthesia typically showed an irregular ulcer in the anal canal a nd an intersphincteric abscess. Surgical treatment consisted of an incision around the ulcer, its excision including margins but not its base, and abs cess drainage. RESULTS: AU patients experienced significant immediate posto perative pain relief. Biopsies of the ulcer showed chronic inflammation, an d no specific agents appeared in cultures. CONCLUSIONS: These lesions seem to have the same cryptogenic origin as perianal abscesses, and we recommend surgical treatment to provide symptom relief.