LYMPHOGRANULOMA-VENEREUM AS A CAUSE OF RECTAL STRICTURES

Rectal strictures are uncommon in young patients without a history of malignancy, inflammatory bowel disease or previous surgery. Lymphogran uloma venereum of the rectum has been described as a rare cause of rec tal strictures in the western world, mainly in homosexual men and in b lacks. It presents with nonspecific symptoms, rectal ulcer, proctitis, anal fissures, abscesses and rectal strictures. Clinical and endoscop ic findings as well as histology resemble Crohn's disease, which may b e misdiagnosed. Serology is often positive for Chlamydia trachomatis b ut negative serology is not uncommon. We present two young black women who suffered from chronic diarrhoea, abdominal pain and weight loss. There was no previous history and investigations showed in both cases a long rectal stricture. Serology was positive in one patient. They we re treated with erythromycin and azithromycin and they both underwent an anterior resection of the rectum. Postoperative histology confirmed the presence of lymphogranuloma venereum of the rectum. We conclude t hat rectal lymphogranuloma venereum is a rare cause of rectal strictur es but surgeons should be aware of its existence and include it in the differential diagnosis of unexplained strictures in high-risk patient s.