Clinical Investigations

FBP - occasionally chronic bleeding can lead to iron deficiency anaemia. Serology - if a syphilitic ulcer is suspected.

Blood glucose - in those with recurrent anorectal sepsis to rule out diabetes mellitus. Microbiology - pus from an abscess should be cultured and antibiotic sensitivities obtained. Proctoscopy - used to inspect the anus and anorectal ring. Biopsy of lesions above the dentate line can be taken without anaesthesia.

Sigmoidoscopy/colonoscopy - should be undertaken when an anorectal condition is thought to be secondary to inflammatory bowel disease.

• MRI scan - useful in delineating the course of complicated fistulae and with ELUS the extent of local tumour spread. CT scan (chest, abdomen and pelvis) will demonstrate local and distant metastases.

• Trucut needle biopsy - used when there is suspicion of recurrent or residual tumour in the ischiorectal fossa.

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