New onset rectal bleeding

  • Brian M. Fung
    Correspondence
    Corresponding author at: Banner – University Medical Center Phoenix, 1111 E McDowell Road, Internal Medicine, LL2, Phoenix, AZ 85006, USA.
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA

    Banner – University Medical Center Phoenix, Phoenix, AZ, USA
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  • Kelly M. Zucker
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA

    Banner – University Medical Center Phoenix, Phoenix, AZ, USA
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  • Joseph David
    Affiliations
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA

    Banner – University Medical Center Phoenix, Phoenix, AZ, USA

    Arizona Digestive Health, Phoenix, AZ, USA
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Published:October 24, 2021DOI:https://doi.org/10.1016/j.ejim.2021.10.010
      A 36-year-old male with no significant past medical history presented to the emergency department for new onset hematochezia. Prior to arrival, the patient reported having five episodes of passing bloody stool and frank blood without associated abdominal or rectal pain, nausea, vomiting, or fever. He denied rectal trauma including anal receptive intercourse. He was not on any prescription medications. On physical examination, his vital signs were normal. His abdominal examination was unremarkable, and digital rectal examination revealed an empty rectal vault. No external hemorrhoids were noted. Laboratory tests were significant for a hemoglobin of 9.0 g/dL (baseline 13.7 g/dL). The patient was admitted, consented, and prepared for colonoscopy scheduled for the next day. The following morning, the patient's hemoglobin was noted to be 6.0 g/dL. After transfusion of 2 units of packed red blood cells, colonoscopy was performed; a lesion is found in the rectum ([ ]Fig. 1A). What is the diagnosis?
      Fig. 1
      Fig. 1Endoscopic images of large rectal ulcer with (A) active bleeding from a large purpuric blood vessel, (B) continued bleeding after injection with 1:10,000 solution of epinephrine, (C) positioning of Ovesco clip pre-deployment, and (D) successful hemostasis after placement of Ovesco clip.

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