CME Article

A 16-Year-Old Girl with Perianal Skin Tags

Prita H. Mohanty, MD; Vibha Sood, MD; Lawrence J. Saubermann, MD

  • Pediatric Annals
  • June 2012 - Volume 41 · Issue 6: 10-12
  • DOI: 10.3928/00904481-20120525-10
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Abstract

CME Educational Objectives

  1. Approach to the diagnosis of Crohn’s disease.

  2. Describe the morphologic characteristics of perianal skin tags of CD on physical examination.

  3. Review the differential diagnosis of anal fissures.

A 16-year-old girl presented to her pediatrician with a 1-year history of intermittent diarrhea and constipation, occasional bright red blood noted in her stools, pain on defecation, and an 8-lb unintentional weight loss. She also complained of difficulty swallowing, heartburn, and profound fatigue. She denied having oral lesions, rashes, joint pains or leg swelling, or eye pain.

She had an unremarkable past medical history, surgery history, and family history.

Examination by her pediatrician revealed hemorrhoids with skin tags. She was prescribed a topical hemorrhoid cream but had a poor response. She was then referred to a surgeon, and the skin tags were excised. In the days that followed, she developed pain on defecation. An anal fissure was noted and a sphincterotomy was performed. The pain persisted and became associated with fever. She was found to have a perianal abscess, so an incision and drainage were performed.

She continued to have perianal pain. The pain was so severe that she was finding it unbearable to sit. Pain was exacerbated by her bowel movements. Because there was no relief even with the use of hydrocodone/acetaminophen at home, she was referred to the emergency department (ED).

AUTHORS

Prita H. Mohanty, MD, is a Fellow, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY. Vibha Sood, MD, is a Fellow, Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY. Lawrence J. Saubermann, MD, is Associate Professor, Department of Pediatrics, and Chief of Pediatric Gastroenterology and Nutrition, University of Rochester Medical Center, Rochester, NY.

Disclosure: Drs. Mohanty, Sood, and Saubermann have disclosed no relevant financial relationships.

Address correspondence to: Prita H. Mohanty, MD, 601 Elmwood Avenue, Box 667, Rochester, NY 14642; ; fax: 585-275-0707; email: Prita_Mohanty@urmc.rochester.edu

doi: 10.3928/00904481-20120525-10

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