Fresh PR blood. Endoscopic biopsy performed, but incomplete colonoscopy.
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Polypoid lesion with muscosal irregularity on the posterior aspect of the lower rectum ( within finger distance on PR examination )
Barium enema is no longer the gold standard for assessment of the rectum, in-fact not even 2nd or 3rd in many centres with the availability of CT colonoscopy and routine use of MRI in localised staging.
This is a now uncommon case of a rectal tumour on barium enema - the irregularity and mucosal destruction indication this polypoid lesion is malignant in nature.