Volume 85 - 2022 - Fasc.2 - Clinical images
A rare and unique inflammatory anorectal lesion
A 50-year-old Caucasian woman, without relevant past medical history, was referred to the gastroenterology consultation due to chronic constipation. She had no previous endoscopic evaluation or past surgeries. The digital rectal examination revealed a soft mobile mass at the lower rectum. Pelvic floor dyssynergia was diagnosed on magnetic resonance defecography and, therefore, biofeedback therapy was started. Colonoscopy revealed a light yellowish sessile polyp with 20 mm at the anorectal junction (Figure 1).
A rare sign of portal hypertension
A 44-year-old male with previous medical history of alcoholism, obesity, hypertension and goiter performed diagnostic work-up consistent with alcoholic liver cirrhosis. Blood tests revealed thrombocytopenia (plate- let count 47x10^9/L) and mild elevation of aspartate aminotransferase, alanine aminotransferase and gamma- glutamyl transferase levels. Albumin, bilirubin and coa- gulation studies were normal. Abdominal ultrasound revealed splenomegaly and, remarkably, multiple puncti- form hyperechogenic foci could be seen dispersed within splenic parenchyma (Figure 1). What is your diagnosis?
A unique case of abdominal pain and anemia
A 38-year-old female presented with intermittent abdominal pain and rectal bleeding and found to have severe anemia. The computerized tomography of abdomen and pelvis with contrast showed a solid mass measuring 5.4 × 3.4 × 3.1 cm in the cecum (Figure 1, left). The colonoscopy revealed a large protruding lesion with ulceration in the right colon (Figure 1,right). Multiple biopsies of the ulcerated area were obtained.
A 25-year-old female with recurrent abdominal pain
A 25-year-old female patient, who had a history of medical treatment with the diagnosis of asthma for the last two years, presented with complaints of abdominal pain, nausea, and vomiting. Similar complaints recurred several times over the previous two months and regressed spontaneously in his medical history. These symptoms were acute onset and lasted for 6-8 hours. She had no history of weight loss or fever. Family history revealed the patient’s mother had a history of recurrent swelling of the face and lips, which resolved spontaneously, and her father had coronary artery disease. Physical examination revealed epigastric tenderness without guarding. Labora- tory test results were within normal limits, except for low hemoglobin level (13.2 g/dL; reference range 14-16 g/ dL). Abdominal ultrasound showed mild peri-intestinal free fluid, and contrast-enhanced abdominal computed tomography (CT) was obtained for further evaluation. Abdominal CT showed an edematous thickening of the duodenum wall and peri-intestinal free fluid (Figure 1). The remaining abdominal CT findings were within normal limits.