Anorectal TB mimicking rectal prolapse in a child: a case re
The present case has been published in the journal Annals of Medicine and Surgery.

A 6-year-old male child presented with the complaint of pain throughout the abdomen but increased intensity in the left lower quadrant for two years. The pain was gradual in onset and dull in nature with no radiation. His abdominal pain increased during defecation.

The pain was constant throughout the day and no relieving factors were described. The patient also had a history of straining during defecation, passage of string-like stool which was occasionally blood stained and abdominal distension.

There was also a history of multiple episodes of self-resolving, non-bilious vomiting which started two weeks before presentation and a three kilogram weight loss over the last six months. There was no history of fever, chronic cough, hemoptysis, chest pain or decreased appetite. He lived with his grandmother who was receiving treatment for pulmonary TB at the time of presentation.

Abdominal examination revealed a distended but non-tender abdomen in all quadrants. Bowel sounds were present. Digital rectal examination revealed a circumferential mass 2 cm from anal verge through which a finger could not be passed.

Colonoscopy revealed a circumferential growth in the anal canal with narrowing of lumen. Contrast enhanced computerized tomography (CECT) scan of the abdomen and pelvis revealed a circumferential enhancing mural thickening involving the rectum and anal canal, with luminal narrowing in the anorectum. Based on biopsy findings, a diagnosis of anorectal tuberculosis was made.

The patient was started on antitubercular therapy consisting of 3 months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by 6 months of isoniazid and rifampicin. There were no signs and symptoms of adverse drug reactions during the course of treatment. Three months after the start of antitubercular therapy a repeat colonoscopy showed no remaining rectal mass. After six months of follow-up he was completely asymptomatic.

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