The incident I am about to narrate is of a 47 years man who is a known alcoholic. His case, though sad, is a peculiar case yet proving the age old medical adage that the abdomen is a pandora’s box. It is about a sad story of how we are easily tricked to not accept diagnostic results. Let me narrate this case.

As said, I had a 47 year old male patient approaching me for piles treatment. He briefly mentioned that he has a history of piles and was operated for it before 7 years. He had pain the anorectal region while passing motion which he believed it was because of recurrence of piles. He also did not hide the fact that he was alcoholic and that he had cyrrosis. He had jauncide as a result of cyrrohsis and was taking medicine and now he is in remission. So basically he had approached me for treating the piles which has begun showing up once again. Well, that is what he thought so as a matter of fact.

I did the first level of body examination. I had reasons to believe that alcoholic cirrhosis features are still present. Then I proceeded with a digital anal examination for the piles he complained. There was piles and along with it was a nodule in the anorectal region. But piles was not the reason for his pain and hence I asked him to get a CT scan report of the abdomen. He insisted that piles was the reason for his pain while passing motion and were in denial mode. He however went with the decision to get a CT scan report. Incidentally, the CT scan of the abdomen showed that his alcoholic cirrhosis condition is still prevalent. But it did not show up anything unusual in the anorectum region but it did mention that there was a mild thickening in the anorectal region. So I requested that he take CEA antigen test and colonoscopy.

I did a colonoscopy on him and was convinced that the condition was not piles. So I sent the tissues taken during colonoscopy for a biopsy. My worst fear came true. Yes, he had cancer – a small tumor indeed that was just developing. The elevated levels of CEASo the symptom of piles was actually cancer in his anorectal region. Sometimes the CT scan report may not throw up any abnormality and this is quite normal given the size of the tumor detected. That is why experienced surgeons like me, are more open to getting a few more diagnoses done to understand the problem holistically. The abdomen is quite unpredictable and that is why it is called a pandora’s box.

The cancer so detected was in its early stage and was manifesting as piles. That is why it is said that symptoms of piles should not be left untreated. It is always prudent to show your piles condition to an experienced piles surgeon. Though 99% of the time, only piles may be diagnosed, it is still better to diagnose it than delaying any onset of cancer and detecting them in later stages.

Coming back to the story, this man did not accept his diagnosis and did not reconcile to the fact that he had cancer. He still maintained that he had piles only and evaded treatments. Surgery still would have been a challenge to him because of his liver cirrhotic condition. If he had undergone surgery, he would have been provided with a permanent colostomy. Though a challenge, he could have still undergone the surgery to avoid metastasis of the cancer present. Surgeons can diagnose and tell the underlying condition holistically and also provide effective treatments only when the patients accept the diagnosis and cooperates for the treatments recommended.

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Dr. Maran is one of the top Bariatric Surgeon in Chennai helping severely obese getting their obesity treatment or weight-loss surgeries.

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