6 // THE NEW GASTROENTEROLOGIST: INSIGHTS FOR FELLOWS & YOUNG GIS WINTER 2016
What’s Your Diagnosis?
By Greg S. Cohen, M.D.
An unusual cause of hematochezia in an elderly man
An 82-year-old man with congestive heart failure was transferred from an outside hospital for fur- ther management of recurrent hematochezia. He had a history of recurrent rectal bleeding since he was a young child, with one episode of hemato- chezia every week on average. He was diagnosed
with ulcerative colitis as a child, but was never treated for
it. He continued to have recurrent hematochezia throughout adulthood, but it had become significantly worse in
the 6 months before admission. He reported hematochezia
“every 6 minutes” the week before admission. He had no
history of proctalgia or tenesmus. He was taking aspirin
81 mg daily until shortly before admission. At the outside
hospital his admission hemoglobin was 8. 9 g/dL. Platelets,
prothrombin time, and partial thromboplastin time were
normal. A colonoscopy was performed at the outside hospital with findings of “purplish inflammation of the rectum
from the anal verge to a distance of 10 cm” (Figure A) with
active rectal bleeding treated with a bipolar probe. Biopsies from this area were normal. Computed tomography
(CT) of the abdomen and pelvis showed concentric rectosigmoid wall thickening with clusters of calcification in the
colon wall (Figures B, C). n
What is the diagnosis?
Dr. Cohen is in the Department of Medicine, Division of Gastroenterology, Northwestern University, Chicago.
Published previously in Gastroenterology (2014;147:943-1188)
See The Answer on page 31