Card 15 / 30: A 25 year old woman is 2 weeks post-partum after an uncomplicated vaginal delivery. She was constipated during her pregnancy requiring the use of laxatives and bulk forming agents. She comes to the emergency room with the acute onset of bright red blood per rectum. She has no pain when moving her bowels and denies any pain in the anal area. She has no fever. Which of the following would you most likely expect to see on anoscopy or flexible sigmoidoscopy?
A) Posterior anal fissure
B) Perianal abscess
C) Second degree internal hemorrhoids
D) Intersphincteric fistula
E) Trans-sphincteric fistula

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