Case 254

Forty-five years-old female patient, nulligravida, born and living in Belo Horizonte. She seeks medical attention complaining of intense anal pain, with sudden onset two days ago. It is associated with swelling in the anal region. She reports straining during the bowel movements in the day before the beginning of the symptoms, irregular bowel habits, low ingestion of fiber and water and smoking. She denies fever and reports small relieve of the pain after a spontaneous local haemorrhage. The physical exam does not show any alterations, except the finding in image 1.