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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
The use of proctoscopy is rare in the gynecological setting. In a surgical setting it is rather routine and commonly used to assess for hemorrhoids, check the mucosa of the lower rectum and take a biopsy that may help in cases of inflammatory bowel disease. Endometriosis causes constricting scarring rather than affecting the mucosa, and it is usually at a higher level in the rectum and sigmoid colon.
Colonoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Ian D. Sugarman, Jonathan R. Sutcliffe
An important component of the examination is palpation to exclude abdominal masses in the right lower quadrant (suggestive of terminal ileitis in Crohn's disease) and perineal inspection. The presence of tags, deep fissures, and induration makes the diagnosis of Crohn's disease more likely and this information may help differentiation from ulcerative colitis. Prior to intubation of the anus, a rectal examination should be performed to exclude a distal polyp. Proctoscopy not only allows visualization of the distal rectum but also allows liquid stool to be drained from within the rectum which in turn improves examination of the rectal ampulla.
Colonic Perforation Pelvic Collection with Air in a Hemodynamically Stable Patient
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
A patient with a pelvic collection secondary to a colonic perforation is more likely to be febrile with tachycardia. In the event of a well walled-off collection, the patient is more often normotensive, although, in a patient with peritonitis and dehydration, the patient could present with hypotension and signs of sepsis. In the case presented above, the patient was febrile with no pallor or icterus and had a coated tongue. The abdomen was mildly distended with suprapubic tenderness and absent bowel sounds. Per rectal examination revealed a bulge anteriorly above the level of prostate. The mucosa of the rectum was normal on proctoscopy.
Prolapsed anorectal malignant melanoma presenting as hemorrhoids
Published in Baylor University Medical Center Proceedings, 2023
Busara Songtanin, Kenneth Nugent, Sameer Islam
The initial management should include biopsy of the mass through colonoscopy or proctoscopy. Findings on endoscopy include a polypoid lesion in the anorectal area or an ulcerated mass with or without pigmentation; these findings can be found after hemorrhoidectomy and can be mistaken for a hemorrhoid.8,11,12 The differential diagnosis includes Paget’s disease, Bowen’s disease, lymphoma, and gastrointestinal stromal tumor. These biopsies require careful pathologic evaluation for clinical staging, especially in amelanotic anorectal melanoma, and tumor mutation panels.13KIT mutations are more prevalent in mucosal melanoma than cutaneous melanoma.14 There is no standard treatment for this condition, but previous studies have suggested treatment based on staging and include surgery (local excision and abdominoperineal resection), pelvic radiation therapy, chemotherapy, and immunotherapy.1,6,15 With adjuvant radiation therapy followed by local excision, the 5-year rates of local control and lymph node control are 82% and 88%, respectively.16
Polyvinylidene Fluoride Mesh Use in Laparoscopic Ventral Mesh Rectopexy in Patients with Obstructive Defecation Syndrome for the First Time
Published in Journal of Investigative Surgery, 2021
Mahdi Alemrajabi, Behnam Darabi, Behrouz Banivaheb, Nima Hemmati, Sepideh Jahanian, Mohammad Moradi
This was an experimental study conducted from August 2013 to August 2017, in a single center. Inclusion criteria were: (i) at least 6 months of conservative management for constipation and ODS, (ii) history of ODS characterized by fragmented stools, need for straining at defecation, sense of incomplete evacuation, tenesmus, urgency, pelvic heaviness and self-digitation, (iii) imaging studies (defecography) suggestive of ODS (presence of anatomical and morphological changes, such as descending perineum, rectocele, enterocele, intussusception, rectal prolapse or a combined disorder and (iv) referred to colorectal surgery clinic by an internal medicine specialist after at least 10 sessions of biofeedback treatment. Exclusion criteria were: (i) prolapsed hemorrhoids or big hemorrhoidal defects, (ii) a major non mesh-related complication before discharge which required surgical interventions and mesh removal and (iii) patients who refused to continue the study. Rigid proctoscopy and conventional defecography were performed for all patients while anorectal manometer studies, colonoscopy and colonic transit time study were used selectively based on patients’ physical examination and history taking.
Rectal actinomycosis mimicking malignancy
Published in Acta Chirurgica Belgica, 2021
Akanksha Rajpoot, Chiranth Gowda, Vidya Monappa, Gabriel Rodrigues
A 56-year-old male presented with painless, post-defaecation fresh bleeding per-rectum of 2 weeks duration. General and per-abdominal examination was unremarkable. Digital rectal examination showed fresh blood and on proctoscopy rectum was full of blood clots with no haemorrhoids, fissures, fistula, growth or strictures. Blood investigations and tumour markers were normal. Colonoscopy done revealed an ulceroproliferative growth with no active bleeding near the rectosigmoid region, suggesting malignancy (Figure 1(A)). Multiple biopsies were taken and histopathology revealed chronic granulomas with fibrous stroma and cyst like spaces containing characteristic granules and gram positive bacteria suggestive of actinomycosis and negative for malignancy (Figure 1(B)). As patient had known penicillin allergy he was started on oral cephalosporin for 4 weeks. Bleeding PR gradually stopped. A repeat colonoscopy done after 3 weeks showed regression of the lesion (Figure 1(C)), hence antibiotics were continued for 4 more weeks on the recommendation of hospital infection control committee (HICC).