[A 64-year-old woman with perianal bleeding, chronic diarrhea and severe fecal incontinence].
Unclear perianal bleeding may cause diagnostic and therapeutic difficulty, particularly when the bleeding source cannot be detected. In this case record we report on a 64-year-old woman with systemic sclerosis and incomplete CRES(T) syndrome diagnosed more than 10 years ago with no detectable teleangiectasia/angiodysplasia at that time. During the course of the disease the initially incomplete CRES(T) syndrome developed into a complete CREST syndrome with repeated bleeding from teleangiectatic/angiodysplastic lesions of the rectum, stomach/duodenum. In addition, chronic diarrhoea with malabsorption, bacterial overgrowth and severe anal incontinence were present which all were seen as intestinal manifestations of the existing underlying disease. A complete motoric and sensoric insufficiency of the anal sphincter was found manometrically, anal endosonography with elastography revealed changes compatible with sclerosis. In the absence of a causal therapy symptomatic treatment strategies are described and discussed on the basis of existing pathophysiologic knowledge.
Innere Medizin, Rehaklinik Ob der Tauber, Bismarckstr. 31, 97980 Bad Mergentheim. allgayer@reha-klinik-odt.de
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Dietrich
D016888:Angiodysplasia / Q000175:diagnosis*; D017675:CREST Syndrome / Q000175:diagnosis*; D003113:Colonoscopy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology*; D054459:Elasticity Imaging Techniques; D019160:Endosonography; D005242:Fecal Incontinence / Q000209:etiology*; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000175:diagnosis*; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis*