A 74-Year-Old Woman Presenting With Acute Rectal Bleeding 1 Week After...
A 74-Year-Old Woman Presenting With Acute Rectal Bleeding 1 Week After...
A 74-year-old woman on low-dose aspirin because of a prior transient ischemic attack presented to the emergency department with sudden onset of rectal bleeding.
One week earlier, she had undergone colonoscopic examination, with removal by hot biopsy of a 6-mm polyp from the transverse colon. At colonoscopy, scars in the most distal part of the rectum and small remnants of previously treated internal hemorrhoids were observed.
Clinical evaluation revealed a patient in good condition, with no signs of significant blood loss. Her blood pressure was 160/95 mm Hg and her pulse rate was 80 bpm. Abdominal examination was unremarkable. Inspection of the perianal region showed no abnormalities. Digital rectal examination revealed fresh blood. Her blood hemoglobin concentration was 124 g/L. The patient was referred to the endoscopic unit to exclude a delayed polypectomy-related bleeding.
An acute flexible rectosigmoidoscopy with no bowel preparation showed blood clots in the rectum (see Figure 1). At the rectosigmoid junction, formed stools with blood streaks at the periphery were seen (see Figure 2). After advancing the instrument to the middle part of the sigmoid colon, normal stools could be observed (see Figure 3).
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Do the findings on rectosigmoidoscopy suggest a diagnosis of delayed polypectomy-related bleeding?
A 74-year-old woman on low-dose aspirin because of a prior transient ischemic attack presented to the emergency department with sudden onset of rectal bleeding.
One week earlier, she had undergone colonoscopic examination, with removal by hot biopsy of a 6-mm polyp from the transverse colon. At colonoscopy, scars in the most distal part of the rectum and small remnants of previously treated internal hemorrhoids were observed.
Clinical evaluation revealed a patient in good condition, with no signs of significant blood loss. Her blood pressure was 160/95 mm Hg and her pulse rate was 80 bpm. Abdominal examination was unremarkable. Inspection of the perianal region showed no abnormalities. Digital rectal examination revealed fresh blood. Her blood hemoglobin concentration was 124 g/L. The patient was referred to the endoscopic unit to exclude a delayed polypectomy-related bleeding.
An acute flexible rectosigmoidoscopy with no bowel preparation showed blood clots in the rectum (see Figure 1). At the rectosigmoid junction, formed stools with blood streaks at the periphery were seen (see Figure 2). After advancing the instrument to the middle part of the sigmoid colon, normal stools could be observed (see Figure 3).
(Enlarge Image)
(Enlarge Image)
(Enlarge Image)
Do the findings on rectosigmoidoscopy suggest a diagnosis of delayed polypectomy-related bleeding?
