IN THE day-to-day practice of medicine, routine or frequently utilized procedures are often regarded as being devoid of danger to the patient. The following case history illustrates the occurrence of an unusual and potentially serious complication after the performance of a presumably innocuous procedure.
Report of a Case
A 34-year-old Caucasian man was admitted to the Rancocas Valley Hospital in Willingboro, NJ because of a three-week history of rectal bleeding during bowel movements. He was otherwise asymptomatic.The past medical history was unremarkable. Physical examination, including a digital rectal examination was normal. The hemoglobin, hematocrit, urinalysis, and fasting blood sugar values were normal.On the second hospital day, an upper gastrointestinal x-ray series was performed. A deformed duodenal bulb, attributed to scarring from previous ulceration was noted. No other abnormalities were seen. On the same day, a sigmoidoscopic examination was performed after a cleansing enema. A hypertrophied anal papilla was