Obstructive perianal lesion in a 75-year-old man.
A 75-year-old man presented with a fungating peri-anal mass which appeared malignant at presentation and required a defunctioning colostomy due to abdominal distension. Multiple biopsies were negative for malignancy and CT/MRI scans showed no malignant mass. A provisional diagnosis of prolapsed haemorrhoids was made and the mass was treated with sugar and charcoal dressings. There was a dramatic resolution of the mass with this treatment and the patient was discharged 1 month post-admission. The patient then underwent an elective haemorrhoidectomy by which time the mass had decreased to a perianal skin tag. The only clues in this case were the acute presentation of the mass, the fact that the mass had appeared post-defecation and that the patient had been diagnosed with haemorrhoids 2 years previously on colonoscopy. This case highlights the importance of evaluating all investigations and considering all differential diagnoses before embarking on definitive management.
General Surgery Department, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK. rudra.k.maitra@gmail.com
Rudra Krishna
RK
Maitra
Thomas
T
Pinkney
Sriram
S
Subramonia
Austin G
AG
Acheson
D000368:Aged; D001003:Anal Canal / Q000473:pathology*; D001004:Anus Diseases / Q000473:pathology* / Q000601:surgery; D001458:Bandages; D002606:Charcoal; D003125:Colostomy / Q000379:methods; D003937:Diagnosis, Differential; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D011230:Precancerous Conditions / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
D002606:Charcoal