No abstract

Tufted angiomas are rare lesions described as slowly growing/spreading erythematous macules especially located in the upper trunk and neck. Herein we report the case of perianal location of a tufted angioma in a young pregnant woman. She came to our observation complaining of perianal pain accompanied by bleeding at defecation. A lesion resembling a perianal fissure was observed. Mild hypertonia of the internal sphincter was confirmed at manometry. After one week of ineffective medical treatment, surgery was planed at the end of the sixteenth week under local anaesthesia. The lesion was excised and a minimal sphincterotomy was performed; histopathology report described features of a tufted angioma. The pregnancy proceeded regularly, without anal symptoms, followed by normal vaginal delivery at the thirty-eighth week. This case showed three peculiar features: the association of tufted angioma and pregnancy, the perianal location, and the clinical appearance suggestive of an anal fissure. The clinical manifestation of a perianal tufted angioma, mimicking an anal fissure, is of utmost importance to the differential diagnosis and treatment plan, especially in a pregnant woman.

Haemorrhoids are believed to be rare in elderly patients, occurring mainly in young and middle-aged subjects. Symptoms of haemorrhoids in elderly patients, in addition, require a precise differential diagnosis in order to rule out neoplasia. In this paper we report our experience in dealing with haemorrhoidal disease in 291 patients older than 65 years. Symptoms of presentation were those commonly reported by younger patients. Accurate clinical examination, proctoscopy and flexible sigmoidoscopy allowed reaching a differential diagnosis in the majority of patients. Extensive colorectal diagnostic screening was required in 28.5% of patients due to the clinical presentation. Treatment was conservative in most cases, with 57.2% of the patients treated medically and 36.7% undergoing rubber band ligation (RBL). In this group of patients no complications occurred although several risk factors were present (e.g. anticoagulant medications, diabetes, cardiovascular diseases). A further 13% of the patients underwent surgery with no complications or mortality. Haemorrhoids in elderly patients occur with features similar to those of other ages and ambulatory treatment can be performed. In particular, RBL can be performed safely even in those patients presenting with associated illness.