Asymptomatic Anorectal Mass in Young Adult

Case at a Glance

An 18-year-old male presents with a newly discovered small, purple, pea-sized protrusion at the anal verge, resembling a blood blister but causing no discomfort.

Patient's Story

The patient noticed a small purple bump located within the anal ring during routine self-examination. He describes the lesion as approximately the size of a small pea, protruding from the skin surface with a blister-like appearance. The patient denies any associated pain, itching, bleeding, or changes in bowel habits. There is no history of straining during bowel movements, chronic constipation, or similar lesions in the past.

Initial Assessment

Physical examination reveals a small, purple, soft tissue mass at the anal verge measuring approximately 5mm in diameter. The lesion is non-tender to palpation and appears to be vascular in nature. The patient is otherwise healthy with no systemic symptoms or signs of infection.

The Diagnostic Journey

Given the location, appearance, and patient demographics, the differential diagnosis includes external hemorrhoid, thrombosed hemorrhoid, anal skin tag, or less likely, a vascular malformation. The purple coloration and soft consistency are most consistent with a hemorrhoidal condition.

Final Diagnosis

External hemorrhoid, likely thrombosed given the purple discoloration

Treatment Plan

Conservative management with over-the-counter hemorrhoid cream containing hydrocortisone and pramoxine. Patient education on proper anal hygiene, dietary fiber intake, and adequate hydration. Sitz baths recommended for symptomatic relief if needed.

Outcome and Follow-up

Patient advised to schedule follow-up with primary care physician if the lesion persists beyond 2-3 weeks, increases in size, becomes painful, or if bleeding occurs. Routine rectal examination recommended for definitive assessment and to rule out other anorectal pathology.