66歲男性以長期肛門疼痛及臀部腫塊為表現之直腸癌診斷

Diagnosis of Rectal Cancer in a 66-Year-Old Man Presenting with Longterm Anal Pain and Hip Masses

肛門疼痛及血便是臨床上常見病徵，常以痔瘡或肛門膿瘍等做初步治療，加上直腸癌罕見以肛門膿瘍表現，易誤導辨識直腸癌的診斷時機。本案例是一位66歲男性，誤認長時間肛門疼痛是肛門膿瘍所致，忽視血便、下腹悶痛及大便型態改變等症狀，直至臉色蒼白、精神虛弱及臀部腫塊嚴重分泌物才就醫治療，經由肛門指診、實驗室檢驗、病理組織及電腦斷層等檢查，逐步確立臨床診斷為直腸腺癌合併肛門周圍軟組織侵犯；經由術前輔助性治療後，進行腫瘤切除手術治療，病情獲得良好控制及門診追蹤治療。臨床執業病患病情變化多元，面對肛門膿瘍併發臀部膿瘍個案，應詳實收集資訊逐步分析病程發展，以影像學證實直腸壁厚度及膿瘍侵犯的範圍，並注重病理檢驗的重要性，勿輕忽直腸癌併發肛門膿瘍的可能性。

Anal pain and bloody stools are clinically common signs that are often treated initially as hemorrhoids or anal abscesses. Anal abscesses, a rare manifestation of rectal cancer, can easily mislead the identification and delay the diagnosis of rectal cancer. In this case, a 66-year-old man mistakenly believed that his long-term anal pain was caused by anal abscesses and ignored symptoms of bloody stools, lower abdominal pain, and changes in stool form. He did not seek medical treatment until he had a pale complexion, mental weakness, and severe discharge from the hip masses. The clinical diagnosis of rectal adenocarcinoma complicated by perianal soft tissue invasion was gradually established through a digital anal examination, laboratory tests, a pathological examination, and computed tomography. After preoperative adjuvant therapy, tumor resection was performed. The disease was well controlled, and the patient was followed up through outpatient visits. Clinical practitioners may encounter patients with various disease conditions. For cases of anal abscesses complicated by hip abscesses, clinicians should gradually analyze the disease course by collecting detailed information, confirming the rectal wall thickness and abscess invasion scope on imaging, and pay attention to the importance of pathological examination to prevent missing the possibility of rectal cancer complicated by anal abscesses.