A case of partial prolapsed hypertrophied multiple anal papillae

A 45-year-old male patient came to our patient department (OPD) with complaints of bleeding per rectum on and off, burning sensation at anal region and feeling of mass at anal region for 6 months. Prolapsed hypertrophied anal papillae as shown in the figure and mild tenderness in the anal region. Presently patient also having chronic fissure in ano and indigestion with irregular bowel habits on and off. In past history patient was having fistula in ano 2 years ago. The treatment advised was fissurectomy with electrodessication and curettage of anal papillae under spinal anesthesia. Patient was advised for IV fluids, Inj. Cefixime 200 mg twice a day, Inj. Pantoprazole 40 mg once day with Inj. Tramadol 50 mg/1ml was given for 2 days. The patient was advised for Anometro gel ointment for local application and oral medication after 2 days. The patient was advised to take sitz bath daily. The patient came for follow-up on 10^th day, after per rectal digital examination and anoscopy, it was revealed that there was no present mass at anal region, a healing wound, no spasm, no tenderness and no active bleeding. Patient was advised to continue oral medications and ointment for a week. The final diagnosis was partial prolapsed hypertrophied multiple anal papillae with chronic fissure in ano while the differentials included anal sentinel tags, piles, condylomata acuminata, cryptitis.