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AIM We introduced primary care access to faecal immunochemical testing (FIT) as a stratification tool for symptomatic patients considered to be at risk of colorectal cancer (CRC) prior to urgent referral. We aimed to evaluate clinical and pathway outcomes during the first 6 months of this novel approach. METHOD FIT was recommended for all patients who consulted their general practitioner with lower gastrointestinal symptoms other than rectal bleeding and rectal mass. We undertook a retrospective audit of the results of FIT, related clinical outcomes and resource utilization on prospectively logged cases between November 2017 and May 2018. RESULTS Of the 1862 FIT kits dispatched by post 91.4% were returned, with a median return time of 7 days (range 2-110 days); however, 1.3% of returned kits could not be analysed. FIT results ≥ 150.0 μg haemoglobin (Hb)/g faeces identified patients with a significantly higher risk of CRC (30.9% vs 1.4%, chi-square 167.1, P

We report an atypical case of prostate cancer with rectal involvement presenting with gastrointestinal symptoms predominately and a rectal mass. A 51-year-old male patient came to the hospital with abdominal pain and rectal bleeding. Imaging revealed prostate enlargement, perirectal lymphadenopathy, and multiple hepatic and pulmonary nodules. The patient also had an elevated prostate-specific antigen (PSA) of 502 ng/mL (against normal range 0.6-0.7 ng/mL). Biopsies were performed on tissue samples taken from the rectum and prostate gland, which confirmed the diagnosis of prostate adenocarcinoma. The lack of urinary symptoms and close clinical similarity to colorectal cancer presented a diagnostic challenge for us. Familiarity with this specific presentation of prostate cancer is necessary to avoid misdiagnoses and guide correct treatment.

Infantile perianal pyramidal protrusion (IPPP) is an uncommon and underreported benign cutaneous lesion characterized by a protrusion from the anal orifice. It is also believed to be often mistaken for other conditions. The unawareness of this lesion may be responsible for underreporting and an excessive concern both in providers and in parents. Timely diagnosis and reassurance need to be emphasized in the provider community. We report an interesting case of IPPP on the first day of life, which was erroneously diagnosed as imperforate anus at her delivery.

This is a case of a 75-year-old man who presented with a 7-month history of a reducible rectal mass. The patient came to the emergency department with a prolapsed necrotic bowel involving a strangulated segment with the rectal mass. He underwent an abdominotransanal resection through a combined abdominal and perineal approach. His postoperative course was unremarkable. Histopathological and immunohistochemical studies showed a rectal carcinosarcoma. Because of a state-mandated lockdown due to the COVID-19 pandemic, the patient failed to follow-up. He was later seen to have metastatic progression. Owing to the poor functional status of the patient, the shared decision of the multidisciplinary team, the patient and his family was to manage him with palliative intent.

When addressing the surgical treatment of a pre-sacral tumor, resection may take place via either the conventional open approach or the more novel trans-abdominal approach with robot assistance. We present a case of a 56-year-old male who underwent the latter for an incidentally discovered 3 cm retro-rectal mass. Four port sites oriented transversely across the abdomen were used to triangulate on the pelvis. After docking of the robot and insertion of the instruments under direct visualization, dissection was carried on into the pelvis, and the rectosigmoid junction was identified. The peritoneum was incised along the right lateral aspect of the rectum and the sacral promontory was exposed. The pre-sacral space was then entered and dissection continued to the pelvic mass. The mass was circumferentially dissected from the surrounding structures, liberated from the pelvis, and removed through the 12-mm trocar site. The peritoneal defect was closed via a self-locking, absorbable suture. Patient consent was obtained for use of media for educational purposes. IRB approval was not required for this non-experimental study. The patient was successfully treated with robot-assisted trans-abdominal excision of his retro-rectal mass and was discharged home on post-operative day one. This surgical technique proved to be both safe and feasible. Continued advancement of robot-assisted surgery may show that a trans-abdominal approach to resection of pre-sacral tumors is superior to the perineal approach.

Highlights • Anorectal malignant melanoma, is a rare and aggressive form of melanoma. • Very different from its cutaneous counterpart. • There is no optimal treatment. Surgery is the mainstay of treatment, but the extent is controversial. • Patient’s quality of life deserves attention when choosing the adequate surgical technic., Introduction Anorectal malignant melanoma (AMM), is a rare and aggressive form of melanoma. Accounts for

In men, prostate cancer is the second most diagnosed cancer worldwide. Typical sites for metastasis include bone, lung, and liver. Prostate cancer with gastrointestinal involvement, particularly rectal, has been rarely reported in the literature. As patients with prostate cancer with rectal invasion may present with symptoms similar to those of other gastrointestinal pathologies, such as anal fissures and rectal carcinoma itself, misdiagnosis and delays in care can result. Direct visualization of the rectum via endoscopy, along with biopsy, allows clinicians to make an accurate and timely diagnosis in patients with prostate cancer with rectal involvement, which in turn leads to broader available treatment options.

Background A novel pathway incorporating faecal immunochemical testing (FIT) for rapid colorectal cancer diagnosis (RCCD) was introduced in 2017. This paper reports on the service evaluation after 2 years of pathway implementation. Methods The RCCD protocol was based on FIT, blood results and symptoms to stratify adult patients in primary care. Two-week-wait (2WW) investigation was indicated for patients with rectal bleeding, rectal mass and faecal haemoglobin (fHb) level of 10 µg Hb/g faeces or above or 4 µg Hb/g faeces or more in the presence of anaemia, low ferritin or thrombocytosis, in all other symptom groups. Patients with 100 µg Hb/g faeces or above had expedited investigation . A retrospective audit of colorectal cancer detected between 2017 and 2019 was conducted, fHb thresholds were reviewed and critically assessed for cancer diagnoses. Results In 2 years, 14788 FIT tests were dispatched with 13361 (90.4 per cent) completed returns. Overall, fHb was less than 4 µg Hb/g faeces in 9208 results (68.9 per cent), 4–9.9 µg Hb/g in 1583 (11.8 per cent), 10–99.9 µg Hb/g in 1850 (13.8 per cent) and 100 µg Hb/g faeces or above in 720 (5.4 per cent). During follow-up (median 10.4 months), 227 colorectal cancers were diagnosed. The cancer detection rate was 0.1 per cent in patients with fHb below 4 µg Hb/g faeces, 0.6 per cent in those with fHb 4–9.9 µg Hb/g faeces, 3.3 per cent for fHb 10–99.9 µg Hb/g faeces and 20.7 per cent for fHb 100 µg Hb/g faeces or above. The detection rate in the cohort with 10–19.9 µg Hb/g faeces was 1.4 per cent, below the National Institute for Health and Care Excellence threshold for urgent referral. The colorectal cancer rate in patients with fHb below 20 µg Hb/g faeces was less than 0.3 per cent. Conclusion Use of FIT to "rule out" urgent referral from primary care misses a small number of cases. The threshold for referral may be adjusted with blood results to improve stratification ., We present outcome data from a service evaluation that demonstrates clinical effectiveness and safety. This strategy may be crucial to overcoming the effects of the Coronavirus pandemic on 2WW and urgent pathways.

Introduction: Surgery remains the mainstay in treating intussusception in developing countries, with a correspondingly high bowel resection rate despite a shift to non-operative reduction in high-income countries. Objective: To assess factors associated with bowel resection and the outcomes of resection in childhood intussusception. Methods: A review of children with intussusception between January 2006 and December 2015 at the University College Hospital, Ibadan, Nigeria. The patients were categorized based on the need for bowel resection and analysis done using the SPSS version 23. Results: 121 children were managed for intussusception during this period. 53 (43.8%) had bowel resection, 61 (50.4%) did not require resection and 7 (5.8%) were unknown. 40 (75.5%) of the resections were right hemi-colectomy. The presence of fever, abdominal pain, distension, rectal mass, age < 12 months, heart rate > 145/min and duration of symptoms > 2 days were associated with the need for bowel resection (p < 0.05). However, only age and abdominal pain independently predicted need for resection. Bowel resection was more associated with development of post-operative complications and prolonged hospital stay (p < 0.05). Conclusion: Infants presenting with abdominal pain and abdominal distension after two days of onset of symptoms were more likely to require bowel resection. Resection in intussusception significantly increased post-operative complications and length of hospital stay. Keywords: Paediatric intussusception; bowel resection; developing countries.

Breast cancer is the leading cause of cancer death in women, and while metastasis is common to areas like the bone, lungs, and brain, it is rare to metastasize to the gastrointestinal tract and especially to the rectum. Due to the rarity of this condition and its resemblance clinically and radiologically to primary gastrointestinal tract tumors, diagnosis and treatment are challenging. We present a case of metastatic lobular mammary carcinoma in a 52-year-old Bahraini woman who presented with an obstructing rectal mass.

A 55-year-old man with a history of tobacco use presented with a 5-day history of diarrhea and rectal bleeding. This was associated with intermittent low-grade fever and weight loss that he was not able to quantify. There was no family history of malignancy. He had traveled frequently within South

A 14-year-old boy presented with complaints of mass descending per rectum for 10 months which was manually reducible and non-progressive in nature. It was not associated with bleeding per rectum or pain or pus discharge. No history suggestive of alteration in bowel habits. No history of any abdominal pain or discomfort, vomiting. He also gives history discoloration around the lips and toes for past one year. The patient also has past history of intussusception for which he underwent exploratory laparotomy. Patient was conscious, oriented. His vitals - BP: 130/90 mmHg, pulse: 84/minute Patient was afebrile at the time of examination. Multiple discrete hyperpigmented macules were present on both lips. Abdomen was soft, non-tender, non-distended. Previous surgical scar was present. Other systems - normal. On digital rectal examination, no external fissures / fistula. A mobile growth was felt at around 5 cms from the anal verge which was mobile which does not bleed on touch.

Malignant fibrous histiocytoma is a type of soft tissue sarcoma that originates from mesenchymal tissues and that mostly affects extremities. Abdominal malignant fibrous histiocytoma usually has a poor prognosis and is rarely seen in the rectum. A 52-year-old female patient presented with rectal bleeding, tenesmus and anemia. She was operated for an obstructive rectal mass and postoperative pathology was reported as malignant fibrous histiocytoma. Herein, we aimed to report a case of malignant fibrous histiocytoma, a rare cause of rectal mass, who was treated with abdominoperineal resection + end colostomy.

Background In the US, syphilis infections have increased 71% since 2014. Proctitis is a rare manifestation of early syphilis transmitted through anal intercourse. We suspect that its misdiagnosis results from physician under-awareness and thus we present the largest case analysis to date of syphilis proctitis. Methods We searched PubMed and Scopus for articles describing cases of proctitis in which Treponema pallidum was a likely causative pathogen based on serologies, and/or organism-specific staining of anorectal biopsy specimens. Furthermore, we conducted chart review to identify cases of syphilis proctitis diagnosed within our health center from 2011-2019. Pertinent data were extracted from the articles and medical records and analyzed to provide a summative account. Results 53 cases of syphilis proctitis were identified in 38 articles. 7 additional cases were diagnosed at our institution, totaling 60 cases. All cases of syphilis proctitis were described in individuals of male sex assignment at birth. The age at diagnosis ranged from 15 to 73 years (average 39 years). In 48 cases (92%) men endorsed sex with men. In 27 cases (56%) individuals were HIV co-infected. Syphilis proctitis presented most commonly with hematochezia (68%) and anal pain (48%). The most common physical exam findings were rectal mass (38%), lymphadenopathy (33%), and rash (31%). Non-treponemal titers averaged 1:60 (range 1:2-1:1024). Endoscopy was performed in 52 cases and most commonly showed anorectal mass (42%) and anorectal ulcer (35%). In 38 cases (68%), histopathology revealed a chronic lymphoplasmacytic inflammatory infiltrate, and in 14 of these cases (37%), prominent plasma cells were described. In 24 cases (77%), treponema immunohistochemical stain revealed spirochetes. Conclusion Syphilitic proctitis should be suspected in boys and men presenting with lower gastrointestinal symptoms. Histopathology, while suggestive, is not pathognomonic, and serology and specific tissue staining are required to make the diagnosis. Given overlapping symptoms and histology with inflammatory bowel disease, the diagnosis may be delayed resulting in personal and public health consequences. A sexual history should be routinely elicited and further testing for syphilis pursued if exposure is suspected. Disclosures All Authors: No reported disclosures

Rektum kanserinin en sık görülen patolojik tipi adenokarsinomdur. Diffüz büyük B-hücreli lenfomanın kolorektal sistem tutulumu çok nadir görülen bir klinik durumdur. Atmış beş yaşında erkek hasta kilo kaybı ve hematokezya şikayetleri ile başvurdu. Rektal muayene ile rektal karsinomu taklit eden bir kitle teşhis edildi ve kolonoskopi ile desteklendi. Rektal kitle biyopsisinin nihai raporu rektal lenfoma olarak raporlandı. Çekilen torakoabdominal bilgisayarlı tomografi rektum çevresinde küçük lenf nodları ve rektum duvarında kalınlık artışı olduğunu gösterdi. Yapılan ek tetkikler başka bir organ tutulumu olmadığını gösterdi. Hasta primer rektum lenfoma tanısı aldı ve hematoloji bölümü tarafından kemoterapi başlandı. Rektal kitle vakalarının ayırıcı tanısında rektal lenfoma gibi nadir patolojiler akılda tutulmalıdır. Hem rektal karsinom hem de rektal lenfoma klinik ve radyolojik çalışmalarda benzer görünümlere sahip olduğundan, ayırıcı tanı zordur., The most commonly seen pathological type of rectal cancer is adenocarcinoma. The involvement of the colorectal tract with diffuse large B-cell lymphoma is a very rare clinical condition. A-65-year old man was admitted with complaints of weight loss and hematochezia. A rectal mass that mimicked rectal carcinoma was diagnosed by rectal examination and supported by the colonoscopy. The final report of the rectal mass biopsy reported as rectal lymphoma. Thoracoabdominal computed tomography was showed rectal wall thickening which surrounded small lymph nodes. Additional examinations didn’t reveal any evidence of infiltration to other organs. The patient diagnosed as primary rectal lymphoma and chemotherapy was started by the hematology department. Rare pathologies such as rectal lymphoma must be kept in mind in the differential diagnosis of rectal mass cases. Since both rectal carcinoma and rectal lymphoma have similar appearances in clinical and radiological studies, it is difficult to make a differential diagnosis.

Crohn's disease (CD) is a chronic relapsing inflammatory disorder that can affect any part of the gastrointestinal tract, from mouth to anus. Bissell et al first described the regional enteritis with perianal disease in 19341.

Herpes simplex virus (HSV) is the leading cause of proctitis in HIV-infected individuals. However, no cases of rectal masses secondary to HSV infection have been reported to date. Herein, we present the case of a 45-year-old man with HIV infection who developed rectal pain and bleeding, along with dysuria and voiding difficulty. Colonoscopy revealed proctitis and a rectal mass with features concerning for rectal cancer. Histologic sections of the rectal mass biopsy demonstrated colorectal mucosa with viral cytopathic changes, ulceration, granulation tissue, marked inflammatory infiltrate, and fibrinopurulent exudate. Immunohistochemistry for herpes simplex virus-1 was positive in epithelial cells demonstrating a viral cytopathic effect. The patient was treated with valacyclovir for 3 weeks, which led to complete resolution of his symptoms. Follow-up sigmoidoscopy at 6 months did not show any masses. Our case illustrates the importance of considering HSV in the differential diagnosis of rectal masses. We advocate the routine use of viral immunohistochemistry for the evaluation of rectal tumors, especially in patients with clinical manifestations and endoscopic findings consistent with proctitis.

A 74-year-old man with a history of prostate cancer presented with rectal bleeding of 6 months' duration. Examination revealed a rectal mass. A diagnostic procedure was performed, and management decisions were made.