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A man in his 60s with a medical history of recurrent pancreatitis, alcohol use disorder and internal haemorrhoids status post haemorrhoidectomy was admitted to the hospital for acute pancreatitis. A contrast-enhanced CT scan incidentally noted an approximately 3cm enhancing mass in the rectum ( figure 1). On further interview, the patient endorsed intermittently painful bowel movements and scant rectal bleeding for the past 2 years. He denied any recent weight loss, constipation or diarrhoea. He reported no pertinent family history, including no known history of colorectal cancer. Social history was notable for tobacco use (1–2 cigarettes per day).