RECTAL MASS

Ask the Following Questions:

1. Is it painful? A painful rectal mass should suggest perirectal abscess, thrombosed hemorrhoid, anal ulcer, ruptured ectopic pregnancy, tubo-ovarian abscess, and pelvic appendix.
2. Is it soft or cystic? The presence of a soft or cystic mass would suggest internal hemorrhoids, polyps, intussusception, villous tumor, granular proctitis, ovarian cyst, and blood or pus in the cul-de-sac.
3. Is it hard? The presence of a hard lesion would suggest a fecal impaction, foreign body, retroverted uterus, enlarged prostate, malignant deposits in the pouch of Douglas, stricture, and carcinoma.
4. Is there associated bleeding? The presence of bleeding should make one suspect carcinoma above all else, but it may be due to internal hemorrhoids, polyps, intussusception, villous tumors, or granular proctitis.

DIAGNOSTIC WORKUP

Routine laboratory tests include a CBC, sedimentation rate, and urinalysis. A smear and culture should be made of any rectal or vaginal discharge. Most cases will be diagnosed by anoscopy and proctoscopy. A pelvic ultrasound and CT scan of the abdomen and pelvis may be useful in evaluating ectopic pregnancy and other gynecologic disorders. Ultrasound of the prostate may also be done to evaluate a prostatic mass. A gynecologist, proctologist, or urologist should be consulted in difficult cases.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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