RECTAL MASS

RECTAL MASS: Excerpt from Differential Diagnosis in Primary Care

Of course, the physician is looking for a rectal carcinoma when performing a routine rectal examination, but what else might be found? Use the mnemonic VINDICATE to have a list of possibilities clearly in mind before the examination. V—Vascular disorders suggest internal and external hemorrhoids. I—Inflammation includes submucous and perirectal abscesses. N—Neoplasms most often manifest as rectal polyps and carcinomas. Other conditions to be remembered include the Blummer shelf of metastatic carcinoma from many sites into the pouch of Douglas, prostatic hypertrophy, and carcinomas.

D—Degenerative conditions are not associated with a rectal mass. I—Intoxication signifies a fecal impaction, particularly from a hunk of barium after a barium enema. C—Congenital and acquired anomalies should remind one of diverticula that may become abscessed and create a mass in the cul-de-sac. They may also recall a pelvic appendix and rectal prolapse. A—Autoimmune conditions include regional ileitis, which may lodge in the cul-de-sac and create a fistula with the rectum. T—Trauma signifies a ruptured bladder. E—Endocrine causes recall the various ovarian tumors and ruptured ectopic pregnancy that will produce a mass in the cul-de-sac. There are, therefore, numerous disorders to keep in mind when examining the rectum.

Approach to the Diagnosis

Anoscopy, sigmoidoscopy, and a barium enema are the most significant tools in the proctologist’s armamentarium. Biopsy or excision of polyps is routine. When one polyp is found, a barium enema or colonoscopy is always done to look for others.

Other Useful Tests

1. CBC (abscess)
2. Sedimentation rate (rectal abscess)
3. Stool for occult blood (carcinoma)
4. Incision and drainage (I & D) and culture of exudate (abscess)
5. Sonogram (ectopic pregnancy, peritoneal metastasis, tubo-ovarian abscess)
6. CT scan of the pelvis (metastasis)
7. Carcinoembryonic antigen (CEA) (colonic neoplasm)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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