Article Text

PDF
Thinking out of the Gut: a case of obscure lower GI bleeding
  1. Frederick H Koh1,
  2. Hian-Li Chan2,
  3. Fredrik Petersson3,
  4. Choon-Seng Chong1
  1. 1Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Singapore, Singapore
  2. 2Department of Haematology-Oncology, National Univeristy Hospital, National University Health System, Singapore, Singapore
  3. 3Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore
  1. Correspondence to Choon-Seng Chong, Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore 119228; choon_seng_chong{at}nuhs.edu.sg

Statistics from Altmetric.com

Clinical presentation

A middle-aged man was admitted for episodes of fresh per-rectal bleeding, which were not associated with defecation. He was recently investigated for macrocytic anaemia in the outpatient haematology clinic. Examination of the perineum revealed grade 1 internal haemorrhoids with no signs of bleeding.

Initial laboratory tests revealed macrocytic anaemia (haemoglobin 10.5 g/dL, normal 12.9–17.0  g/dL; mean corpuscular haemoglobin 95.3 fL, normal 80.0–95.0  fL). Peripheral blood film showing blasts, dysplastic neutrophils, nucleated red blood cells and hypogranular platelets.

The patient underwent a sigmoidoscopy and rubber band ligation of the internal haemorrhoids after persistent fresh per-rectal bleeding. The bleeding persisted with the development of hypotension and a significant drop of haemoglobin to 4.8 g/dL requiring blood transfusions …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.