Ravikumar, a 35-year-old male farmer, presented with a 1-year history of bleeding per rectum and altered bowel habits for 6 months. On examination, a hard ulceroproliferative growth was felt at 5 cm from the anal verge, involving the whole circumference of the rectum. Proctoscopy revealed an irregular-shaped growth on the anterior rectum without surrounding inflammation. The patient was diagnosed with Dukes stage B carcinoma of the rectum.

1. Growth per
Rectum
Ashutosh Carpenter

2.  Name : Ravikumar
 Age / sex: 35y/m
 Residence:katni
 Occupation:farmer

3. Chief complains
 c/o bleed per rectum -1 year
 Altered bowel habits- 6 months
 Pain- 4 months back.

4. HOPI
 Patient initially had c/o streak of blood on stools, 1 year back which not
associated with pain. And around 10 months back he has c/o passage of
blood (bright red in colour) around (10-20 ml)along with stools, and last 2
months c/o passage of blood per rectum mixed with mucus whose
frequency was initially 1 episode in 15 days but has now increased to 2-3
episodes /week.
 He has complaints of increased frequency of motion(2/day to 6-7
episodes /day) with frequent c/o constipation for which the patient takes
laxative.
 He had episode of pain per rectum, since 4 months back which was ,
insidious in onset, non colicky ,constant and dull aching in nature, mild to
moderate in intensity, non radiating sometimes aggravated by defecation
and was relieved on taking medications.
 Sleep disturbances as the patient has to wake up in early morning to
evacuate bowel in which there is usually passage of blood along with
mucus last 2 months.

5.  c/o loss of weight (52 to 45kg ) last 6 months and loss
of appetite due to decreased hunger no c/o abdominal
distension or vomiting or pain(8 chapati to 3 chapati per
day).
 n/o c/o mass coming out per rectum or pruritus.
 n/o c/o abdominal distension/ jaundice/fever.
 No c/o cough/hemoptysis.
 n/o c/o difficulty in micturation, sexual dysfunction or
passage of mucus or blood in urine.
 n/o c/o tenesmus or incontinence.
 No h/o radiation in past.

6. Past history
He was treated 4 months back for bleed per
rectum(? haemorrhoids) at local quack but his
symptoms persisted.
No p/h/o PTB/BA/HTN/DM/COPD or any other
chronic medical or surgical illness

7. Personal history:
 Patient take non vegetarian diet
 Bladder function are normal.
 No history of addiction to alcohol or tobacco.

8. Family history
 No c/o similar complains in any family
member or relatives.

9. O/E
 The patient was examined with proper
consent in adequate light ,
 The patient is conscious /oriented to time /
place and person.
 The patient is average in built.
 Ht -150cm wt -46kg

10.  P- 80/min taken in right radial artery which is
regular/ normovolumic and there is radio
radial or radiofemoral delay.
 BP- 116/76 mmHg taken in left brachial artery
in supine position.
 e/o pallor(+)
 No e/o icterus /cynosis/clubbing/ generalised
or cervical lymphadenopathy .

11. Per abdominal examination
 Inspection:
 The abdomen is exposed from nipple to knee
which is normal in contour, not distended , no e/o
any lump present.
 All quadrants moves proportionately with
respiration .The umbilicus is central and inverted.
 No e/o any dilated veins /scars/or
lymphadenopathy present
 No cough impulse seen on hernial orifices.

12. palpation
 The findings of inspection are confirmed on
palpation.
 On superficial palpation there in increase in
temperature or tenderness.
 Abdomen is soft and no guarding /rigidity or
any palpable lump present.
 No inguinal or cervical LN pathy present.
 There is no organomegaly , no cough
impulse over the hernial orifices.

13. ascultation
 Ascultation
BS+
 Percussion:
Puddle sign negative .
Liver span is normal.
Tympanic note present over the abdomen.

14.  CNS- cons/oriented
 CVS-S1S2 +
 R/S –AEBE

15. Per rectal examination
 Per rectal examination is done in Sims
position after taking consent and explaining
the procedure.
 on inspection:
No e/o any fistula / growth /sentinel pile /any
infection present in peri anal area

16. on digital examination
 Normal anal tone and squeeze present.
 Growth
An ulceroproliferative hard growth felt at 5 cm from anal verge with well
defined margins, irregular in shape no induration of base , which has involved
whole circumference of rectum, around 1 cm longitudinal width, mobility over
rectal wall not possible, mucosa over growth is non mobile, getting above the
growth is possible, and finger can be insinuated between prostate and growth,
similarly finger can be insinuated b/w sacral curve and growth posteriorly and
presence of blood over finger present.
No perianal or rectal wall tenderness present.
Rest of mucosa is normal/ no prostatomegaly.

17. proctoscopy
 On proctoscopy:
ulceroproliferative growth seen at 5 cm from
anal verge, well defined margins, irregular in shape
no surrounding inflammation , which has involved
whole circumference of rectum, around 1 cm
longitudinal width, more growth on anterior aspect
than posterior
No e/o any polyp/ ulcer or haemorrhoid and rest of
the anal canal and rectum is normal.

18. summary
 Patient initially had c/o streak of blood on stools, 1 year c/o
passage of blood per rectum mixed with mucus last 2 months
 Altered bowel habits- 6 months
 He also has e/o pain -4 months back
An ulceroproliferative hard growth felt at 5 cm from anal verge with
well defined margins, irregular in shape no induration of base , which
has involved whole circumference of rectum, around 1 cm
longitudinal width, mobility over rectal wall not possible, mucosa
over growth is non mobile, getting above the growth is possible, and
finger can be insinuated between prostate and growth, similarly
finger can be insinuated b/w sacral curve and growth posteriorly
and presence of blood over finger present.

19.  CARCINOMA of rectum with Dukes stage B
without involvement of clinically detectable LN
with no spread to the viscera or adjacent
structures .