What's Your Diagnosis? Rectal Bleeding

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Evidence-Based Management of Pulmonary Embolism in the Emergency Department correct.

Case Presentation: Emergency Department Management of Patients With Rectal Bleeding

A 24-year-old man presents with abdominal pain, weight loss, and bright-red blood per rectum…

The patient’s temperature is 37°C; heart rate,120 beats/min; blood pressure, 90/55 mm Hg; and oxygen saturation, 100%.
His physical examination is remarkable for mild diffuse abdominal tenderness to palpation. Hemorrhoids or fissures are absent on anal examination, and digital rectal examination demonstrates a mixture of blood, stool, and mucus.
You wonder whether this patient requires an emergent proctosigmoidoscopy, triple-contrast abdominal CT, or whether he can simply be discharged with confirmed GI follow-up…

Case Conclusion

You obtained basic metabolic, hematologic, inflammatory markers, hepatic function, as well a urinalysis. Other than mild elevation of his inflammatory markers, the rest of his laboratory evaluation was normal. The patient underwent advanced CT imaging, which demonstrated inflammatory changes around the rectum without abscess or perforation.

He received IV fluids and antiemetic therapy, and he said he felt better. You were concerned about a new diagnosis of IBD, specifically ulcerative colitis. In addition to sending C difficile testing, you discussed the case with the gastroenterology specialist, who said she could see the patient in clinic next week for consultation and colonoscopy.