Bluish Ovoid Mass In Rectum

TABLE 1 3-1 ■ Abnormalities of the Anus, Surrounding Skin, and Rectum (Continued)

External Hemorrhoids

(Thrombosed)

External hemorrhoids are dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. They seldom produce symptoms unless thrombosis occurs. This causes acute local pain that is increased by defecation and by sitting. A tender, swollen, bluish, ovoid mass is visible at the anal margin.

Polyps of the Rectum

Polyps of the rectum are fairly common. Variable in size and number, they can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult or impossible to feel even when in reach of the examining finger. Proctoscopy is usually required for diagnosis, as is biopsy for the differentiation of benign from malignant lesions.

Cancer of the Rectum

Internal Hemorrhoids (Prolapsed)

Anterior

Posterior

Prolapse of the Rectum

Internal hemorrhoids are an enlargement of the normal vascular cushions that are located above the pectinate line. Here they are not usually palpable. Sometimes, especially during defecation, internal hemorrhoids may cause bright red bleeding. They may also prolapse through the anal canal and appear as reddish, moist, protruding masses, typically located in one or more of the positions illustrated.

On straining for a bowel movement the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red tissue. A prolapse involving only mucosa is relatively small and shows radiating folds, as illustrated. When the entire bowel wall is involved, the prolapse is larger and covered by concentrically circular folds.

Rectal Shelf

Rectal Shelf

Ulcerated Melanoma Perianal

Asymptomatic carcinoma of the rectum makes routine rectal examination important for adults. Illustrated here is the firm, nodular, rolled edge of an ulcerated cancer. Polyps, as noted above, may also be malignant.

Widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. A firm to hard nodular rectal "shelf' may be just palpable with the tip of the examining finger. In a woman, this shelf of metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus.

TABLE 1 3-2 ■ Abnormalities of the Prostate

Proctoscopy Prostate

Normal Prostate Gland

As palpated through the anterior rectal wall, the normal prostate is a rounded, heart-shaped structure about 2.5 cm in length. The median sulcus can be felt between the two lateral lobes. Only the posterior surface of the prostate is palpable. Anterior lesions, including those that may obstruct the urethra, are not detectable by physical examination.

Benign Prostatic Hyperplasia

Obliterated Median Sulcus Bph

Starting in the 5 th decade of life, benign prostatic hyperplasia becomes increasingly prevalent. The affected gland usually feels symmetrically enlarged, smooth, and firm though slightly elastic. It seems to protrude more into the rectal lumen. The median sulcus may be obliterated. Finding a normal-sized gland by palpation, however, does not rule out this diagnosis. Prostatic hyperplasia may obstruct urinary flow, causing symptoms, yet not be palpable.

Cancer of the Prostate Cancer of the prostate is suggested by an area of hardness in the gland. A V|li distinct hard nodule that alters the l[ ^ contour of the gland may or may not be palpable. As the cancer enlarges, it feels irregular and may extend beyond the confines of the gland. The median sulcus may be obscured. Hard areas in the prostate are not always malignant. They may also result from prostatic stones, chronic inflammation, and other conditions.

Prostatitis

Acute prostatitis (illustrated here) is an acute, febrile condition caused by bacterial infection. The gland is very tender, swollen, firm, and warm. Examine it gently.

Chronic prostatitis does not produce consistent physical findings and must be evaluated by other methods.

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Responses

  • leigh
    What is bluish ovoid mass?
    3 months ago

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