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Thursday, 5 December 2013

Proctitis – Misdiagnosis

Proctitis is defined as a condition of inflammation of the anus and the lining of the rectum (i.e., the distal 10–12 cm) of that can lead to bowl discomfort, bleeding, a discharge of mucus or pus, etc.
A. Misdiagnosis
1. Hirschsprung’s disease
Allergic proctitis and abdominal distention mimicking Hirschsprung’s disease in infants.In the study to determine the incidence and clinical aspects of allergic proctitis (AP) in infants with symptoms that mimic Hirschsprung’s disease (HD), found that in the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful.In the infants with severe abdominal distention, the incidence of AP mimicking HD was relatively high. Therefore, consideration of AP should be part of the differential diagnosis in infants with severe abdominal distention or findings that mimic HD. For differentiation of these disorders, a rectal suction biopsy is very useful(30).
2. Diffuse cavernous haemangioma of the rectum (DCHR)g masquerading
Diffuse cavernous haemangioma of the rectum (DCHR) is a rare benign vascular neoplasm that affects mainly young adults and can present with rectal bleeding or massive haemorrhage. There is a report of a case of DCHR masquerading as proctitis which was diagnosed many years ago following colonoscopy, according to St. George’s Hospital NHS Trust, London(31).
3. Colitis cystica profunda and solitary rectal ulcer syndrome-polyoid variant
Colitis cystica profunda and solitary rectal ulcer syndrome-polyoid variant are related chronic benign disorders with characteristic histological features. There is a report of a case of colitis cystica profunda and solitary rectal ulcer syndrome-polypoid variant that was misdiagnosed initially as an ulcerative proctitis, according to the study by Ben-Gurion University of the Negev, Beer-Sheva, Israel(32).
4. Rectal strictures
Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscopic findings as well as histology resemble Crohn’s disease, which may be misdiagnosed/ According to the study by King’s College Hospital, rectal lymphogranuloma venereum is a rare cause of rectal strictures but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patients(33).
5. Etc.
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Sources
(30) http://www.ncbi.nlm.nih.gov/pubmed/17953729
(31) http://www.ncbi.nlm.nih.gov/pubmed/22739216
(32) http://www.ncbi.nlm.nih.gov/pubmed/17142179
(33) http://www.ncbi.nlm.nih.gov/pubmed/9640444