Question: A 69-year-old woman presented to the emergency department of our hospital for a painful perineal mass, which had appeared 6 hours before. Her past medical history included chronic constipation, Waldestrom disease, hypothyroidism, and coronary artery disease. The perineal examination showed a nonreducible, edematous, and partially necrotic mass, exteriorized from the anus (Figure A). Abdominal examination was normal. Vital signs were normal. Blood tests showed an inflammatory syndrome with 11 × 109/L leucocytes and C-reactive protein at 73.9 mg/L.