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Fecal impactions occur in both sexes at any age but are particularly concentrated in children, in the institutionalized or impaired elderly, and in patients with certain psychiatric disorders or medical conditions that predispose to obstipation. The clinical consequences may be disabling and occasionally life threatening. Clinical manifestations include fecal incontinence, abdominal distention and pain, anorexia, weight loss, intestinal obstruction, and stercoral ulceration with bleeding or colonic perforation. Diagnosis begins with recognition of possible fecal impaction and confirmation by digital examination or abdominal radiography. Management consists of disimpaction, colon evacuation, and a maintenance bowel program to prevent recurrent impactions.

We report herein, a rare case of a 32 year old man who presented with a massive sacrococcygeal tumor found by digital examination. A transrectal biopsy was performed, however, as massive anal bleeding occurred 1 day later, an abdominal perineal resection was carried out. Histologic examination subsequently revealed the giant tumor to be pure seminoma. Residual masses of seminoma were detected by CT examination 1 month postoperatively and, despite irradiation, the patient died 26 months after the operation. Although there have been reports of extragonadal seminoma being located in the retroperitoneum, mediastinum and pineal body, this is the first reported case of it being found in the sacrococcygeal region.

This study investigates whether digital examination of the anal canal can differentiate reliably between competent and incompetent sphincters. Digital examinations were performed by an experienced proctologist who was blinded with regard to the patient's history as well as manometric and endoscopic findings. There was poor correlation between manometric findings and digital assessment of anal sphincter tone. The sensitivity of digital examination for diagnosing incompetent sphincters ranged from 63% to 84%, whereas specificity was calculated as only 57%. It is concluded that even the experienced examiner needs to use more sophisticated methods than digital examination for the evaluation of anal sphincter competence.

digital examination and proctoscopy did not reveal any definite local cause of bleeding. The patient was sent to the department of radiology for computed tomography (CT) scan. CT was done on 64 multislice CT scan, which shows marked rectosigmoid wall thickening as a result of varices and vascular malformations and phleboliths of the rectosigmoid colon. The patient was subjected to abdominal surgery in which a sphincter-saving procedure was done. Postoperative course in the hospital was uneventful. J Gastrointest Surg (2009) 13:1017–1018 DOI 10.1007/s11605-008-0535-6

The results of 317 transrectal puncture biopsies of the prostate, performed during eight years, are reported. In applying the method even in cases of the slightest suspicion of prostatic carcinoma arising on digital examination, the rate of positive findings in 45.4%. Complications are few and mild. The advantages which make transrectal puncture biopsy of the prostate the method of choice in a large number of cases are discussed.

1. The digital examination of the rectum and the test of a fecal specimen for occult blood should be a routine part of each physical examination.