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In large intestine, the presenting symptoms in the decreasing order of frequency are abdominal pain, bleeding per rectum, altered bowel habits, painful defecation, malena, general weakness, abdominal discomfort, constipation, perianal pain, anorexia and diarrhea.
Presenting complaints in these patients were painful defecation and constipation in all 60 patients, bleeding per rectum in 55, discharge per rectum in 26, sentinel pile in 32 and pruritus in 11 patients.
In this series bleeding per rectum (92%) was most common symptom followed by mass prolapsing per anus (84%).
One patient had bleeding per rectum 2 months post operatively which stopped with conservative management and on 6 months follow up there was no complaint.
In our study most common symptom was pain while defecation with almost all the patients had anal musculature spasm, followed by bleeding per rectum. Most of the patients had associated constipation.
Sim AJ et al [13] following sclerosant injections, 4 out of 18 patients initially presenting with bleeding per rectum did not have further episodes of bleeding within the three year follow-up period compared with 13 out of 17 patients treated with band ligation.
Per rectum examination did not reveal any residual foreign body.
Patients with complaints of painful defecation with or without bleeding per rectum of more than 6 weeks duration were labeled as chronic fissure-in-ano and considered for this study.
A 94-year-old patient presented with a 3-month history of rectal pressure, bright red bleeding per rectum and a prolapsing mass that came out of her rectum after bowel movements.
We present a case of a86 years old hypertensive male with the history of fresh bleeding per rectum, dizziness, fatigability and palpitation for last 12 hours who came to the emergency room in January 2015 He was stabilized and resuscitated.
The anxious mother was reassured that the ring would pass per rectum, and was instructed to monitor the stools for the next few days.