An elderly woman with dementia is brought in by her daughter for a “rectal mass.” On examination you notice a moist pink mass protruding from the anus, which is nontender. It is soft and does not have any associated bleeding. Which of the following is most likely?
A) Rectal prolapse
B) External hemorrhoid
C) Perianal fistula
D) Prolapsed internal hemorrhoid
A) Rectal prolapse
Rectal prolapse is occasionally seen in chronic constipation. It represents actual rectal tissue which has protruded through the anus. In young children it is associated with cystic fibrosis as well as other conditions. An external hemorrhoid or a prolapsed internal hemorrhoid is not moist and does not have the same mucosa. A perianal fistula represents a connection from the bowel to the exterior apart from the anus and can be associated with inflammatory bowel disease, especially Crohn's disease.
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