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A 31 year old woman presented with vaginal faecal discharge and anal pain. Her past medical history was significant for a 20 year history of severe migraine treated with ergotamine based suppositories. Two months prior to admission, she started reporting constipation and having anal pain on defecation. Three weeks prior to admission, she reported a vaginal faecal discharge initially on defecation but later even on passing flatus. Her systemic evaluation showed no other sign or symptom. Physical examination and laboratory data were all normal. Rectal examination revealed a painful circular stenosis 3 cm cephalad to the dentate line. Rectoscopy was performed (figs 1–3).
What does rectoscopy show (figs 1–3)?
See page 1824 for answer
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Conflict of Interest Statement
D C Baumgart and A U Dignass received an unrestricted research grant from Fujisawa, DACH, GmbH, Munich, Germany in the past.
Robin Spiller, editor
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