title: Resolution of constipation, anal stricture, and iron deficiency anemia after iron infusion: an analogy with Plummer Vinson syndrome.
abstract: BACKGROUND
  Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus. Laboratory reports revealed microcytic hypochromic anemia with iron deficiency. A colonoscopy performed with a GIF XQ180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet, local anesthetics with a trial of mesalamine was initiated but the patient continued to have symptoms. He was referred to a hematologist for an evaluation of anemia and was started on intravenous (IV) iron infusion.
  
  
  RESULTS
  The patient's symptoms of constipation, anal stricture and iron deficiency anemia resolved with iron infusion over 3 months. A repeat rectal exam was painless and confirmed resolution of anal stricture.
  
  
  CONCLUSIONS
  IV iron supplementation combined with conventional anal dilatation presents as a promising approach toward the treatment of anal strictures.
authors.affiliation: Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY USA ; Division of Gastroenterology, Wyckoff Heights Medical Center, Brooklyn, NY USA.
authors.forename: Vijaypal
authors.identifier: 0000-0001-9644-6661
authors.initials: V
authors.lastname: Arya
authors.affiliation: Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Singh
authors.affiliation: NYU Langone Medical Center, Manhattan, NY USA.
authors.forename: Shashank
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Vijaypal Arya Physician P.C., 7554 Metropolitan Avenue, New York, NY USA.
authors.forename: Arjun
authors.initials: A
authors.lastname: Ohri
keywords: Anal stricture; Iron deficiency anemia; Plummer Vinson syndrome