Rectal Mass

62/F MT

Chief Complaint: Abdominal Pain

History:
• 3 months PTA, patient experienced minimal abdominal pain, 3/10, diffused,
accompanied with difficulty of passing stools with noted decreased in caliber (from the
usual banana shaped mass to multiple small and round stools). No consult done. No
medications taken.
• 1 month PTA, persistence of signs and symptoms along with sudden onset early satiety
and anorexia led to consult at a local clinic where patient was given lactulose and
vitamins for the weight loss
• 1 week PTA, progression of abdominal pain now 6/10 prompted consult with another
physician where she was scheduled to undergo colonoscopy
• Few hours PTA, pain progressed to 8/10 now with complain of abdominal enlargement.
She also reported that her last BM and flatus was 5 days PTA. Persistence led to ER
consult and was subsequently admitted and referred to our service

PMH – (+) CS x1

FH – DM type 2, HTN, (+) hx of colon cancer - father

PE
Awake, afebrile
No jaundice
Anicteric sclera
Distended abdomen, no gross lesions seen, hypoactive bowel sounds, soft, with direct
tenderness on all quadrants, no rebound
DRE: no external lesions, collapsed rectal vault, with a palpable hard mass about 6cms from the
rectal vault, intraluminal, non-moveable, located anteriorly, no other masses palpated, with
noted black stools and no blood at the examining finer
BP 139/70
PR 91
RR 18

Laboratories/Imaging

COVID-19 RT PCR Test – awaiting

SFA

CBC
Hgb 12.9
Hct 0.36
Wbc 6.2
Seg 0.73
Lympho 0.26
Mono 0.01
Plt 354

Na 136.50
K 3.66

PTT 27.2
INR 1.019
PT 12.4
% activity 91%

Creatinine 0.59
Hgt 165
Albumin 32.9

Chest Xray – Normal Chest

Admitting diagnosis – Complete Intestinal Obstruction probably secondary to rectal mass

For Exploratory Laparotomy
OR done: Sigmoid Loop Colostomy, Proctosigmoidoscopy with biopsy of the rectal mass