We report the case of a 40-year-old woman who presented to the emergency department with a 1-day history of rectal bleeding with clots.
Other symptoms: anorectal pain at defecation, urge incontinence and constipation for a year.
The rectal bleeding resolved spontaneously 24 hours after admission.
Patient was self-administered with paracetamol-codeine (500/300 mg) due to chronic headache.
Physical examination: normal, but very painful rectal examination, showing indurated and irregular areas in the rectal mucosa, fresh blood appearing in gloves.
Analytical, chest X-ray and abdomen: normal.
Total colonoscopy: loss of the normal vascular pattern of the rectal area, as well as a large diffuse ulceration of the area with isolated pseudopolyps, extending about 10 cm from the anal margin.
Pathological anatomy: nonspecific ulceration.
Computed tomography: concentric rectal stenosis and perirectal adenopathies.
Serology and tuberculin were negative.
At this time, the patient was questioned again, who finally admitted the administration of 16 mg paracetamol-codeine daily for the last year.
The patient was then diagnosed with rectal cancer secondary to acetaminophen-deine derivatives, in addition to opiates syndrome confirmed and followed by Psychiatry.
Episodes were suspended and treatment with hydrolytic enemas was initiated, along with benzodiazepines for opioids.
The patient improved significantly and was discharged.
Those performed 2 and 6 months after discharge showed progressive improvement and cure of rectal lesions.
Treatment was discontinued at 8 months.
At 10 months she was completely asymptomatic.
