This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB. This is a 56-year-old man who presented with hematokinesia, a syndrome of colonoscopy showing a couple of small adenomas. We're focused in retroflexion here on the area immediately to the right, the whitish area immediately to the right of the instrument. That's the area where you'll be asked to make the diagnosis. For clarification, I've circled the area in question with a yellow line. So the correct answer is prolapse change, in this case on an internal hemorrhoid, and this can present as rectal bleeding or as the symptom of prolapse. There is no suggestion of any mass effect, elevated irregular edges. The edge is very smooth at the junction between the ulceration and the intact mucosa. You can see this kind of change as you do here in the absence of significant hemorrhoids. You can just have mucosal prolapse of that mucosa in the very distal rectum. So in the lower right there, there is some ulceration, and again, no suggestion of any elevated edge, anything that would suggest tumor. But most of the time when you see this, it's in association with a hemorrhoid, as it is in this case, another case down at 6 o'clock, you see a hemorrhoid with ulceration, typical appearance of an internal hemorrhoid with prolapse change on it.

hematokinesia

adenomas

colonoscopy

prolapse change

internal hemorrhoid