Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Sections
    • Collections
  • Podcasts
  • Author Info
    • Overview for authors
    • Publication fees
    • Forms
    • Editorial policies
    • Submit a manuscript
    • Open access
  • Careers
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial Board
    • Contact
  • CMAJ JOURNALS
    • CMAJ
    • CMAJ Open
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CJS
  • CMAJ JOURNALS
    • CMAJ
    • CMAJ Open
    • JAMC
    • JPN
CJS

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Sections
    • Collections
  • Podcasts
  • Author Info
    • Overview for authors
    • Publication fees
    • Forms
    • Editorial policies
    • Submit a manuscript
    • Open access
  • Careers
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial Board
    • Contact
  • Subscribe to our alerts
  • RSS feeds
  • Follow CJS on Twitter
Case Note

Lymphogranuloma venereum as a cause of rectal stricture

Ilia Pinsk, Nav Saloojee and Martin Friedlich
CAN J SURG December 01, 2007 50 (6) E31-E32;
Ilia Pinsk
*Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nav Saloojee
†Department of Medicine, the Ottawa Hospital and University of Ottawa, Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Friedlich
*Department of Surgery, the Ottawa Hospital and University of Ottawa, Ottawa, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

Patients presenting to surgical clinics with rectal strictures are uncommon. Diagnostic evaluation is carried out with the purpose of differentiating them from the common causes of rectal stricture (including inflammatory bowel disease and malignant disease). There are few reports describing rectal stricture as a late complication of chronic proctitis associated with lymphogranuloma venereum (LGV) infection. We present a case of a patient with a rectal stricture caused by LGV to illustrate the diagnostic approach and treatment of this rare condition.

Case report

A 45-year-old man was referred to our surgical clinic for investigation of rectal bleeding and anal discomfort. His medical history indicated he was HIV positive. His CD4 count was 360 × 106/L and his viral load was undetectable. No abnormalities were found on perianal inspection. Digital rectal examination revealed a mass-like lesion with some irregularity producing a circumferential stricture. Rigid sigmoidoscopy showed a mass in the distal rectum. Colonoscopy showed a rectal stricture extending from 11 cm to 8 cm from the anal verge (Fig. 1). The scope could pass through the stricture. Although this was not a fibrotic stricture, the circumferential nature of the lesion created a strictured appearance. The remaining colon and ileum were endoscopically normal. Biopsy specimens of the stricture showed ulceration superimposed on an atypical lymphoid infiltrate. There was mild to moderate acute and chronic inflammation in the lamina propria with no evidence of dysplasia or malignancy and no indication of cytomegaloviral infection on immunohistochemical stain. Blood measurements were noncontributory. Pelvic MRI showed diffuse, up to 3 cm, thickening of the rectum for a distance of 10 cm from the anal verge. The MRI scan favoured an inflammatory process over a malignant lesion in view of the long segment of involvement and inflammatory changes. The infectious disease service was consulted, and because LGV was suspected clinically he was started on doxycycline. Serologic examination confirmed LGV. A follow-up colonoscopy was performed at 5 weeks, which showed near resolution of the stricture, and another colonoscopy at 6 months showed complete resolution (Fig. 2).

FIG. 1
  • Download figure
  • Open in new tab
  • Download powerpoint
FIG. 1

Colonoscopy showed an irregular, circumferential rectal stricture. The stricture started 11 cm from the anal verge and extended distally for a distance of 3 cm.

FIG. 2
  • Download figure
  • Open in new tab
  • Download powerpoint
FIG. 2

Colonoscopy 6 months after treatment with doxycycline shows complete resolution of the rectal stricture.

Discussion

LGV is an emerging and significant public health concern in western Europe and recently in Canada.1,2 It is a sexually transmitted infection caused by Chlamydia trachomatis. LGV proctitis is often mild, but chronic cases can be associated with serious complications. If LGV is misdiagnosed or partially treated, the natural history of chronic long-lasting inflammation of the rectum may include the development of fissures, perianal abscess and strictures of the rectum.3,4 Some patients have undergone anterior resection for a presumed malignant lesion only to have the diagnosis of LGV established after histologic examination of the specimen.3,5 Ideally, diagnosis should be made before initiating specific treatment. However, in certain circumstances, the initiation of antibiotic treatment based on clinical suspicion may be appropriate. This case demonstrates that appropriate treatment with doxycycline1 in suspected cases of LGV can result in remarkable improvement and even resolution of rectal strictures.

Although this disease is rare, LGV should not be forgotten in the differential diagnosis of rectal problems including rectal strictures. In view of the increasing incidence of LGV in the West, it is important for physicians to be acutely aware of LGV proctitis in high-risk patients.

Footnotes

  • Competing interests: None declared.

  • Accepted July 21, 2006.

References

  1. ↵
    1. Kropp RY,
    2. Wong T
    . Emergence of lymphogranuloma venereum in Canada. CMAJ 2005;172:1674–6.
    OpenUrlFREE Full Text
  2. ↵
    1. Nieuwenhuis RF,
    2. Ossewaarde JM,
    3. Gotz HM,
    4. et al
    . Resurgence of lymphogranuloma venereum in western Europe. Clin Infect Dis 2004;39:996–1003.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Papagrigoriadis S,
    2. Rennie JA
    . Lymphogranuloma venereum as a cause of rectal strictures. Postgrad Med J 1998;74: 168–9.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Ruther U,
    2. Rupp W,
    3. Muller HA,
    4. et al
    . Rectal pseudotumor due to Chlamydia trachomatis in a male homosexual. Endoscopy 1990;22:237–8.
    OpenUrlPubMed
  5. ↵
    1. Parkash S,
    2. Radhakrishna K
    . Problematic ulcerative lesions in sexually transmitted diseases: surgical management. Sex Transm Dis 1986;13:127–33.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Journal of Surgery: 50 (6)
CAN J SURG
Vol. 50, Issue 6
1 Dec 2007
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CJS.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Lymphogranuloma venereum as a cause of rectal stricture
(Your Name) has sent you a message from CJS
(Your Name) thought you would like to see the CJS web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Lymphogranuloma venereum as a cause of rectal stricture
Ilia Pinsk, Nav Saloojee, Martin Friedlich
CAN J SURG Dec 2007, 50 (6) E31-E32;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Lymphogranuloma venereum as a cause of rectal stricture
Ilia Pinsk, Nav Saloojee, Martin Friedlich
CAN J SURG Dec 2007, 50 (6) E31-E32;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Alerts
  • RSS

Authors & Reviewers

  • Overview for Authors
  • Publication Fees
  • Forms
  • Editorial Policies
  • Submit a manuscript

About

  • General Information
  • Staff
  • Editorial Board
  • Contact Us
  • Advertising
  • Reprints
  • Copyright and Permissions
  • Accessibility
  • CMA Civility Standards
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 2291-0026

All editorial matter in CJS represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected].

View CMA's Accessibility policy.

Powered by HighWire