ANAL STENOSIS SIMULATING ANORETAL TUMOR AS THE FIRST MANIFESTATION OF CROHN'S DISEASE: CASE REPORT (Atena Editora)

Abstract

Introduction: Crohn's disease (CD) has a median age at diagnosis of 29.5 years and only 5% of cases are diagnosed from intestinal strictures. These are less frequent than fistulas and, when they do occur, are more frequent in the ileum and less frequently in the colon. Case report: A 50-year-old male patient complained of progressive constipation, anal pain, increased defecation effort and hematochezia. During an outpatient investigation, in 2016, he underwent colonoscopy, which showed low rectal stenosis, insurmountable by the device. In a new attempt at colonoscopy in 2017, additional ulcerated lesions were described at the anal margin associated with stenosing fibrosis that prevented the device from progressing, marking the beginning of suspected anorectal tumor. However, the anatomopathological examination showed no signs of malignancy. With the worsening of the symptoms, he was referred to Coloproctology in 2019, due to the suspicion of neoplasia. Examination under narcosis was indicated for anal dilatation and collection of anatomopathological material. The new anatomopathological examination showed that the elevated lesion was a fibroepithelial polyp, while the examination of the rectal mucosa showed an intense chronic inflammatory process with fibrosis and crypt microabscesses suggestive of IBD. Discussion: Although IBDs can occur at any age, CD is usually diagnosed between the ages of 15 and 35. It is also noteworthy that the main symptoms of Crohn's disease are diarrhea, abdominal pain and weight loss, with stenosis being the cause of diagnosis in only 5% of cases. Faced with advanced age, changes in bowel habits, obstructive symptoms and weight loss, the differential diagnosis with anorectal neoplasia is essential.

Conclusion: The diagnosis of stenosing IBDs must be kept in mind as a differential in the face of obstructive symptoms, even in patients with epidemiology and clinics compatible with neoplasia, to avoid delaying treatment and its complications.