RECTAL MASS

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.

1. V—Vascular suggests internal and external hemorrhoids.
2. I—Inflammation includes submucous and perirectal abscesses.
3. 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.
4. D—Degenerative conditions are not associated with a rectal mass.
5. I—Intoxication signifies a fecal impaction, particularly from a hunk of barium after a barium enema.
6. 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.
7. A—Autoimmune conditions include regional ileitis, which may lodge in the cul-de-sac and create a fistula with the rectum.
8. T—Trauma signifies a ruptured bladder.
9. E—Endocrine recalls the various ovarian tumors and ruptured ectopic pregnancy that will produce a mass in the cul-de-sac.

RECTAL MASS

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. I & D and culture of exudate (abscess)
5. Sonogram (ectopic pregnancy, peritoneal metastasis, tubo-ovarian abscess)
6. CT scan of the pelvis (metastasis)
7. CEA (colonic neoplasm)

Book Source Details

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

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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

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