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Endgames Spot Diagnosis

An irregular ulcer in the rectum

BMJ 2021; 372 doi: (Published 18 February 2021) Cite this as: BMJ 2021;372:n316
  1. Qiang Wang, professor of dermatology1,
  2. Ji-Na Zheng, dermatology postgraduate1,
  3. Jian-Min Xu, professor of surgery2,
  4. Yun-Shi Zhong, professor of surgery2
  1. 1Department of Dermatology, Zhongshan Hospital, Fudan University, Shanghai, China
  2. 2Department of Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
  1. Correspondence to Q Wang wangqiang7766{at}

A man in his 50s was referred to hospital by his general practitioner with a suspected rectal lesion after rectal examination. He had also experienced intermittent constipation without rectal pain for five years, which he had managed with self-administered simple enemas once a week for the past three years, but these were not effective at relieving the constipation. He had a medical history of intolerance to penicillin. Full details of his sexual history could not be elicited.

Digital rectal examination showed a non-tender rectal lesion of about 3 cm in diameter on the left side of the rectum; it had a smooth base, was slightly raised, and had indurated borders.

Relevant laboratory test results are shown in table 1.

View this table:
Table 1

Relevant laboratory test results

Magnetic resonance imaging showed irregular low rectal wall thickening (about 4 cm …

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