1. Constipation, pain, and
blood-stained rectal drainage
A 56-year-old man presented to the emergency department with a history of constipation, abdominal pain, and blood-stained mucus drainage from the rectum. The patient had no fever; vital signs were stable. A vague fullness was felt in the lower abdomen. Rectal examination revealed anal warts; a patulous anal sphincter; and a smooth, mobile, firm mass above the dentate line.
Abdominal films showed a smoothly marginated, cylindrical tubular filling defect that projected toward the lower abdominal and pelvic regions, with the long axis in a craniocaudal orientation.
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