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Obstructive perianal lesion in a 75-year-old man.
Rudra Krishna Maitra1, Thomas Pinkney, Sriram Subramonia
1General Surgery Department, Nottingham University Hospitals, Queens Medical Centre, Nottingham, UK. rudra.k.maitra@gmail.com
BMJ Case Reports
|July 18, 2012
Summary
A fungating perianal mass initially suspected as malignant resolved dramatically with conservative treatment for prolapsed hemorrhoids. This case underscores the importance of considering differential diagnoses and evaluating all investigations for accurate patient management.
Area of Science:
- Gastroenterology and Colorectal Surgery
- Surgical Pathology and Diagnostics
Background:
- A 75-year-old male presented with an acute, fungating perianal mass initially suspicious for malignancy.
- The patient required a defunctioning colostomy due to abdominal distension.
- Initial investigations including biopsies and imaging (CT/MRI) failed to confirm malignancy.
Observation:
- A provisional diagnosis of prolapsed hemorrhoids was made.
- The perianal mass showed a dramatic resolution following treatment with sugar and charcoal dressings.
- The mass significantly reduced to a perianal skin tag by the time of elective hemorrhoidectomy.
Findings:
- Despite initial malignant appearance, the mass was histopathologically benign.
- The acute presentation, post-defecation onset, and prior hemorrhoid diagnosis were key diagnostic clues.
- Conservative management led to complete resolution, negating the need for oncological intervention.
Implications:
- Highlights the critical importance of thorough differential diagnosis in perianal masses.
- Emphasizes re-evaluation of all diagnostic data before definitive surgical or oncological management.
- Suggests conservative treatment may be effective for certain acute perianal conditions initially mimicking malignancy.
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