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October 28, 2019

Image challenge: A rare cause of rectal pain

What caused tenesmus, rectal pain and rectal bleeding in a 30-year-old woman with sarcoidosis and chronic pain?
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Gastroenterology clinical image challenge: A 30-year-old woman with sarcoidosis and chronic pain presented with tenesmus, rectal pain, and rectal bleeding. She was evaluated in the emergency department for new-onset constipation several days prior and was discharged with stool softeners and a hydrocortisone topical suppository owing to concern for internal hemorrhoids. Stool softeners did not relieve her constipation, so she used several over-the-counter products. Her daily home medicines include prednisone, hydrocodone, tramadol and ibuprofen.

Physical examination revealed a young woman in significant distress with the inability to sit down owing to pain. External evaluation of the anus was normal. Internal evaluation was refused. Laboratory testing revealed a normal basic metabolic panel, complete blood count and hepatic function panel. HIV and stool studies were negative. A computed tomography scan of the abdomen and pelvis was obtained revealing abnormal findings (figure), which prompted endoscopic evaluation. Flexible sigmoidoscopy was performed the following day (figure).

What is the diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.

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