Anal Achalasia: The Rat Tail Gas Sign

A 29-year-old woman presented with 7 years of abdominal pain, distension, bloating, incomplete rectal evacuation, and food intolerance. Prior gastrointestinal endoscopies, abdominal ultrasound, and computerized tomography (CT) scans were nondiagnostic. Abdominal examination showed distension, tympanic percussion note, and general tenderness, but no guarding or rebound. Rectal examination showed high anal sphincter tone, levator muscle tenderness, no perineal descent, and anal contraction while straining to evacuate the examining finger.

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