Bright Red Blood per Rectum

Abstract

A 72-year-old female presents to the emergency department reporting an episode of a large volume of bright red blood per rectum 4 hours earlier. She states that the toilet was filled with blood. The patient reports that the bleed was painless and was not associated with a bowel movement, and she thinks it stopped about 2 hours ago. She has never had rectal bleeding before. She denies fevers and chills. A colonoscopy 2 years ago only demonstrated a few diverticula but no polyps. She has not lost weight recently. Her past medical history is significant for hypertension, and chronic constipation. She has had no prior surgery. On physical examination, her blood pressure is 135/88 mmHg, and heart rate is 80/min. She is afebrile and has a normal respiratory rate. She appears to be pale and anxious. Cardiac and lung exams are normal. Abdominal exam reveals no surgical scars and no masses. Her abdomen is non-distended, has normal bowel sounds, and is nontender to palpation, without rebound tenderness or guarding. Digital rectal exam reveals gross blood in the rectal vault but no masses. Anorectal exam shows no enlarged hemorrhoids and no fissures. Laboratory values reveal hemoglobin of 8 g/dL (normal 12–15.2 g/dL), hematocrit of 24% (37–46%), and normal mean corpuscular volume (MCV).