Rectal squamous cell carcinoma (SCC) is a rare entity whereas anal SCC is the most common malignancy of the anal canal. We discuss a case of 78 year old man who presented to us with 2-month history of altered bowel habits and anorexia. On evaluation, by digital rectal examination there were two growths one at 2 cms and another at 8 cms from anal verge. Multiple biopsies were negative for malignancy. He underwent PET/CT scan which confirmed one mid-rectal and another anal canal growth with high SUV uptake, suspicious of malignancy. He underwent a laparoscopic abdomino-perineal resection and the final histopathology showed synchronous rectal and anal SCC. This is only the second case of synchronous rectal and anal SCC reported in English literature. We discuss the challenges faced in the diagnosis and management of this case.
Pseudomembranous colitis, also called antibiotic-associated colitis, is caused by the gram-positive anaerobic bacterium
Clostridium difficile
(C.difficile)
. The infection is common in elderly patients on chronic antibiotic use and in immunosuppressed patients. We report a rare case of pseudomembranous colitis in a 49-year-old male who presented with cramping abdominal pain, abdominal distension, and loose stools, without any pre-existing immunosuppression or chronic drug intake. The computed tomography (CT) picture was suggestive of fulminant ulcerative colitis and the patient underwent total colectomy in view of severe disease. This patient also had rectal bleeding caused by a bleeding pseudoaneurysm of the right internal pudendal artery, which posed diagnostic and therapeutic challenges. Embolization of the pseudoaneurysm was done in the post-operative period. Though the clinical and radiological pictures were suggestive of ulcerative colitis in our patient, this was disproved in the histopathological examination and by the negative serum anti-
Saccharomyces cerevisiae
antibodies (ASCA) testing. The presence of extensive pseudomembranous colitis in this patient masked the bleeding pseudoaneurysm of the internal pudendal artery, as bleeding is a common presentation in fulminant colitis, leading to a delay in the management of the pseudoaneurysm. Such a presentation was not reported in the literature to the best of our knowledge. Considering co-existent pathologies, especially in patients who present with an unobvious clinical picture, can prevent delay in the definitive diagnosis of these conditions.
Gastrointestinal tuberculosis (TB) mainly presents as an ileocecal disease, and colonic TB is more often seen with terminal ileal involvement. Isolated involvement of the descending colon by TB is uncommon and usually presents with chronic colitis. An acute presentation as intestinal obstruction because of tubercular stricture of the descending colon has not been reported. We encountered a young woman who presented with features of acute bowel obstruction. On evaluation, she was diagnosed with a case of descending colon stricture with a provisional diagnosis of malignant colonic stricture. Left hemicolectomy was performed, and histopathology revealed it to be tubercular stricture. Antitubercular therapy was given for 9 months, and she is doing well at follow-up. A differential diagnosis of TB at an unusual location should always be considered even when presented with atypical symptoms, especially for patients from the endemic zone of TB.
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