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Proctitis
From WikEM
Contents
Background
Causes
- Radiation treatment
- Autoimmune
- Vasculitis
- Ischemia
- Infectious (STI and enteric organisms)
Clinical Features
- Inflammation of the rectal mucosa
- Pain on defecation
- Tenesmus
- Mucoid discharge
- Inguinal lymphadenopathy (may be seen with T. pallidum)
Differential Diagnosis
Anorectal Disorders
- Anal tags
- Hemorrhoids
- Cryptitis
- Anal fissure
- Anal fistula
- Anorectal abscess
- Proctitis
- Rectal prolapse
- Rectal foreign body
- Pruritus ani
- Pilonidal cyst
- Constipation
- Condyloma acuminata
- Anal cancer
- Colorectal tumor
- Pedunculated polyp
- Crohn Disease
- Syphilitic fissure
- GC/Chlamydia
Evaluation and Management
Condyloma Acuminata
Gonorrhea
- Symptoms vary from none to severe rectal pain with yellow, bloody discharge
- Unlike nonvenereal cryptitis, infection is not confined to the posterior crypt
- Diagnosis made by Gram stain and culture
- Also consider dissemination to heart, liver, CNS, and joints
- Treatment: ceftriaxone 125mg IM + azithromycin 2gm PO single dose
Chlamydia
- Infection due to direct anorectal infection or via vaginal seeding to perirectal lymphatics
- Symptoms range from asymptomatic to anal pruritus, pain, purulent discharge
- Lymphogranulomatous variety
- Acutely painful anal ulcerations associated with unilateral lymph node enlargement
- Fever and flulike symptoms
- May result in rectal scarring, stricturing, perirectal abscesses, chronic fistulas
- Treatment
- Non-LGV: Azithromycin 2gm PO x1 or doxycycline 100mg PO BID x7d
- LGV: Doxycyline 100mg PO BID x21d
Syphilis
- Primary
- Anal chancres appear ~2-6 wks after intercourse, are often painful
- May be misdiagnosed as simple fissure
- Symmetric lesion on opposite side of anal margin is distinguishing feature
- Inguinal adenopathy is often present
- May be misdiagnosed as simple fissure
- Anal chancres appear ~2-6 wks after intercourse, are often painful
- Secondary
- Condylomata lata (flatter and firmer than condylomata acuminata)
- Treatment
- Penicillin G 2.4mil IM x1
Herpes Simplex Virus-2
- Itching and soreness in perianal area progressing to severe anorectal pain
- Accompanied by flulike illness, inguinal adenopathy
- Early lesions are small, discrete vesicles on erythematous base
- Vesicles then enlarge, coalesce, and rupture, forming exquisitely tender ulcers
- Treatment
- Acyclovir 400mg PO TID x10d for initial episode; 800mg TID x2d for recurrent episodes
