26th April 2024

A 42-year-old man presents with a 2-month history of sharp anal pain during defecation, followed by throbbing discomfort lasting for several hours.

A 42-year-old man presents with a 2-month history of sharp anal pain during defecation, followed by throbbing discomfort lasting for several hours. He reports seeing small amounts of bright red blood on the toilet paper after bowel movements. He has no significant past medical history and takes no medications. On examination, his abdomen is soft and non-tender. Digital rectal examination is aborted due to extreme pain.

Which is the most likely diagnosis?