Recurrent lower gastrointestinal bleeding in an 87-year-old woman

Description

An 87-year-old woman presented to an outside hospital with a complaint of bright red blood per rectum (BRBPR), where her haemoglobin was found to be 4.6 g/dL. An extensive gastrointestinal (GI) work was performed, including oesophagogastroduodenoscopy, colonoscopy and a video capsule endoscopy, followed by a superior mesenteric artery (SMA) angiogram which showed no active extravasation. The patient continued to have BRBPR and was transferred to our hospital for further work-up. Her medical history was significant for hypertension, hyperlipidaemia and coronary artery disease. Her surgical history included knee arthroplasty, hernia repair, hysterectomy, cholecystectomy and appendectomy. Physical examination of the abdomen was soft, non-distended and non-tender. On transfer, a CT enterography was obtained and could not identify the source of bleeding but did note some stenosis of the superior mesenteric artery (SMA). A colonoscopy was then performed, which revealed old blood in her colon, but no active bleeding was found. A subsequent nuclear tagged...

http://ift.tt/2oYLCOf