Endoscopic Ultrasound and Anal Pain: The Key to Diagnosis

A 73-year-old male patient with a history of pulmonary uberculosis in childhood, a gastric adenocarcinoma (intestial type) T1N0M0 (TNM classification), submitted to a partial astrectomy Roux-en-Y, 10 years before, and a T1 lowrade papillary bladder urothelial carcinoma treated with transurethral resection and epirubicin, 1 year before, eported anal pain and fever for the last 5 days. The atient denied diarrhea, hematochezia or weight loss. In he anoscopy a painful bulging lesion with 2--3 cm was etected in distal rectum. Anorectal endoscopic ultrasonoraphy (EUS) showed a heterogeneous, irregular lesion in