What’s Your Diagnosis?
An intriguing case of bright red blood per rectum
A 36-year-old man with a history of seizure dis- order, mental retardation, and recurrent as- piration requiring percutaneous endoscopic gastrojejunostomy tube for feedings presented to the emergency room with bright red blood per rectum. He was also complaining of gener-
alized abdominal pain. The patient was hemodynamically
stable on presentation but the initial hemoglobin mea-
surement was low at 6. 5 g/dL and he was transfused 2
units of packed red blood cells. An abdominal radiograph
showed moderate colonic gaseous distension with numer-
ous cystic lucencies of various sizes throughout the colon
(Figure A). Subsequently, CT of the abdomen showed
numerous round pockets of gas within the walls of the
ascending, transverse, and descending colon (Figure B).
After this, a bedside sigmoidoscopy was performed re-
vealing several small erythematous areas in the rectum
without active bleeding and irregular mucosa with possi-
ble blebs in the descending colon (Figure C).
What is the diagnosis?
Dr. Helo is in the department of radiology, Loma Linda University Medical Center, Loma Linda, Calif.; Dr. Rhee is in the
department of internal medicine, Medicine Institute, Cleveland
Clinic, Cleveland; Dr. Dugum is in the division of gastroenterology, hepatology and nutrition, department of medicine, University of Pittsburgh. The authors disclose no conflicts.
Published previously in Gastroenterology (2014;149:e1-2)
By Naseem Helo, M.D., Katherine Rhee, M.D., and Mohannad Dugum, M.D.
See The Answer on page 15