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Gut. 2007 April; 56(4): 508.
PMCID: PMC1856850

An unusual internal pile

Monitoring Editor: Robin Spiller

Clinical presentation

A 60 year old female underwent total colonoscopy for recurrent painless haematochezia. She reported no past medical history of abdominal or anorectal symptoms. Physical examination was unremarkable. Digital rectal examination detected a firm, non‐tender mobile nodule in the posterior upper anal canal. Laboratory studies showed no anaemia or abnormal coagulation profile. Anal margin examination was normal. Mild diverticulosis was found in the sigmoid area. A polypoid protuberant polychromatic lesion of 10 mm diameter was noted just above the dentate line at the level of the internal haemorrhoids (fig 11).

figure gt96982.f1
Figure 1 A 10 mm protuberant polychromatic polypoid lesion at the top of the anal canal, adjacent to the internal piles, as seen during endoscopy in retroflexed view (upper panels) and direct view (lower panels).


What is the diagnosis?

See page 517 for answer

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