Haemorrhoids (Differential Diagnosis as before)

Region of the anus and external genitals in a 8.5-year-old girl. 2 irregular bluish nods are visible in the perianal and anal region at 1 to 5 o'clock. The diagnosis is mixed hemorrhoids grade 3; their volume is increased by pressure on the belly by the examiner's hand. Blood in the stool, the presented signs, and unspecific symptoms such as anal itch and soiling point to a hemorrhoidal disease. In case of evacuation of blood by the anus, always a precise inspection of the anus belongs to the differentiation from an acute intussusception. An anal fissure, trauma to the anus, perineum and external genitals, and hemorrhoids can be excluded mostly by this clinical tool. Yet, hemorrhoids are not always recognizable as clearly as in the presented child with portal hypertension and cystic fibrosis.