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Self inflicted rectal ulcer: hearing is believing
  1. A Hokama1,
  2. F Kinjo1,
  3. R Tomiyama1,
  4. A Saito1,
  5. H Kikkawa2,
  6. H Miyazato2
  1. 1First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
  2. 2Department of Psychiatry, University of the Ryukyus, Okinawa, Japan
  1. Correspondence to:
    Dr A Hokama
    First Department of Internal Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; hokama-amed.u-ryukyu.ac.jp

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QUESTION

A 54 year old woman presented with haematochezia of two weeks duration. She gave no history of straining at defecation or taking non-steroidal anti-inflammatory drugs. Physical examination was unremarkable. A colonoscopic image, showing a shallow longitudinal ulcer involving the anterolateral wall of the lower rectum and anal canal, is depicted in fig 1. Biopsies showed non-specific inflammation without the presence of fibromuscular obliteration. What further information should be obtained to make a definitive diagnosis? What is the most likely diagnosis?

Figure 1

Colonoscopic image, showing a shallow longitudinal ulcer involving the anterolateral wall of the lower rectum and anal canal.

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