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JAMA Surgery Clinical Challenge
April 2014

An Uncommon Surgical Disease

Author Affiliations
  • 1Department of Digestive Surgery, Military Hospital Desgenettes, Lyon, France
  • 2Department of Digestive Surgery, Military Hospital Robert Picqué, Bordeaux, France
  • 3Emergency Medicine, St Vincent's Medical Center, Bridgeport, Connecticut
  • 4Department of Colorectal Surgery, University Hospital, Grenoble, France
JAMA Surg. 2014;149(4):395-396. doi:10.1001/jamasurg.2013.808

A woman in her 50s was hospitalized for a painful anal mass. She had a history of hypertension and depression and was receiving omeprazole and paroxetine. The mass had appeared 2 days before presentation and was associated with vomiting. Additionally, the patient had not passed stools or had intestinal gas for 2 days. On physical examination, the mass was exteriorized through the anal canal. It was covered by hypoxemic rectal mucosa, but no digestive lumen could be identified inside the mass (Figure 1). Furthermore, the patient had a distended abdomen, absent bowel sounds, and no tenderness to palpation. No abdominal scar was visible, and no groin hernia was palpable. Her blood pressure was 160/80 mm Hg and her temperature was 37.8°C. Results of complete blood cell count, coagulation tests, and basic chemistry panel were all within normal limits. An abdominal radiograph showed several air-fluid levels without pneumoperitoneum, confirming an intestinal occlusion.

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