An 84-Year-Old Man With a Lower Gastrointestinal Bleed
An 84-Year-Old Man With a Lower Gastrointestinal Bleed
An 84-year-old man was admitted to clinic in the early hours of the morning with the complaint of an episode of acute rectal bleeding. He noted bright red blood per rectum at 11 pm the previous evening, which persisted for 30 minutes. He called the emergency services 3 hours later, and had no memory of the intervening time interval.
The patient had a past medical history of noncritical coronary artery disease and had received a subtotal colectomy for stage III colon carcinoma 3 years previously, with a negative endoscopy and negative restaging in the year prior to admission. He also had a known abdominal aortic aneurysm of < 5 cm and an iliac artery aneurysm, which was followed by computed tomography (CT) scan. In the distant past, he had had a partial gastrectomy for peptic ulcer disease. A vena cava filter had been placed for deep venous thrombosis, and he was not taking anticoagulant therapy. He also had a history of coronary artery disease, renal insufficiency, and diabetes treated with glyburide.
On physical examination, the patient was normotensive with no postural signs. The abdomen was minimally tender over the left lower quadrant. His laboratory values were unremarkable, other than elevated creatinine of 3.4 mg/dL. His white cell count was 6.8 x 10 cells/mm, hematocrit was 29.71%, mean corpuscular volume was 84 fL (normal range, 80-98 fL), and platelets were 400 x 10 cells/mm. Prothrombin time, partial thromboplastin time, and international normalized ratio were within normal limits.
Results of gastric lavage performed in the emergency room were unremarkable.
Which of the following should be considered in the clinical diagnosis?
View the correct answer.
<p>A-F</p>
An 84-year-old man was admitted to clinic in the early hours of the morning with the complaint of an episode of acute rectal bleeding. He noted bright red blood per rectum at 11 pm the previous evening, which persisted for 30 minutes. He called the emergency services 3 hours later, and had no memory of the intervening time interval.
The patient had a past medical history of noncritical coronary artery disease and had received a subtotal colectomy for stage III colon carcinoma 3 years previously, with a negative endoscopy and negative restaging in the year prior to admission. He also had a known abdominal aortic aneurysm of < 5 cm and an iliac artery aneurysm, which was followed by computed tomography (CT) scan. In the distant past, he had had a partial gastrectomy for peptic ulcer disease. A vena cava filter had been placed for deep venous thrombosis, and he was not taking anticoagulant therapy. He also had a history of coronary artery disease, renal insufficiency, and diabetes treated with glyburide.
On physical examination, the patient was normotensive with no postural signs. The abdomen was minimally tender over the left lower quadrant. His laboratory values were unremarkable, other than elevated creatinine of 3.4 mg/dL. His white cell count was 6.8 x 10 cells/mm, hematocrit was 29.71%, mean corpuscular volume was 84 fL (normal range, 80-98 fL), and platelets were 400 x 10 cells/mm. Prothrombin time, partial thromboplastin time, and international normalized ratio were within normal limits.
Results of gastric lavage performed in the emergency room were unremarkable.
Which of the following should be considered in the clinical diagnosis?
Diverticulitis
Angiodysplasia
Ischemic colitis
Neoplasm
Aorto-enteric fistula
Radiation proctitis
Duodenal ulcer
All of the above
A-F
View the correct answer.
<p>A-F</p>