0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Image of the Month—Quiz Case FREE

Joseph Mareno Jr, MD; Kazuaki Takabe, MD, PhD; Omid Bakhtar, MD; Sonia Ramamoorthy, MD
[+] Author Affiliations

Author Affiliations:Departments of Surgery (Drs Mareno and Ramamoorthy) and Pathology (Dr Bakhtar), University of California, San Diego; and Department of Surgery, Virginia Commonwealth University, Richmond (Dr Takabe).


Section Editor: Grace S. Rozycki, MD, MBA


Arch Surg. 2008;143(5):513. doi:10.1001/archsurg.143.5.513.
Text Size: A A A
Published online

A 43-year-old African American woman with no significant medical history presented with 10 years of rectal pain. Initially, the pain was intermittent, mainly associated with her menstrual period, but recently it had become chronic and debilitating. No bleeding or discharge was observed. A perianal examination showed no fistula, abscess, or hemorrhoids. There was no tenderness on palpation. Colonoscopy revealed a diverticulum of the left anorectal wall with a 5-mm opening, which everted on suctioning. Radial endoscopic ultrasonography revealed a tubular anechoic area in the perirectal space along the left anorectal wall.

The patient was referred for surgery. Examination under anesthesia revealed a diverticular opening immediately above the dentate line (Figure 1). The surrounding mucosa was slightly erythematous but not ulcerated. Intraoperative fluoroscopy demonstrated a 3-cm diverticulum that extended laterally and superiorly, terminating in a blind pouch. The diverticulum was excised in total and the defect was closed primarily.

Place holder to copy figure label and caption
Figure 1.

Intraoperative photograph revealing the rectal diverticulum opening just above the dentate line.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Transsphincteric fistula-in-ano

B. Chronic anal fissure-in-ano

C. Heterotopic gastric mucosa

D. Rectal neoplasm

Figures

Place holder to copy figure label and caption
Figure 1.

Intraoperative photograph revealing the rectal diverticulum opening just above the dentate line.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections