Perianal Itching in Surgery — 32yo Man | General Surgery | SMLE Q#1322
SMLE Question #1322
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 32-year-old man has 1 week of severe sharp anal pain during and after defecation, leading to stool avoidance. He notices bright red blood streaks on stool and toilet paper with perianal itching. He denies fever, purulent discharge, or perianal swelling. On examination with gentle separation of the buttocks, there is a very tender superficial ulceration at the posterior midline of the anal canal. What is the most likely diagnosis?
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