A 64-Year-Old Woman With Recurrent Gastrointestinal Bleeding

Juan Carlos Munoz, MD; Matthew S. Cole, MD, MPH

Disclosures

March 31, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us .

Background

A 64-year-old black woman is directly transferred from her primary care provider's office to the emergency department because she presented with symptomatic anemia and several episodes of painless rectal bleeding. During an initial assessment, the patient states that she "can hardly walk" and that she has dyspnea on exertion, chest pain, and "ringing in the ears."

She denies any history of gastrointestinal ulcers, liver disease, or bleeding disorder. Although no medication list is available on admission, she denies anticoagulant, aspirin, and nonsteroidal anti-inflammatory drug (NSAID) intake. The patient also denies smoking and alcohol and recreational drug use.

The patient's medical history is remarkable for type 2 diabetes mellitus, colonic diverticulosis, chronic anemia, recurrent rectal bleeding, colonic polyps, coronary artery disease, hypertension, and end-stage kidney disease requiring hemodialysis.

When further queried about her medical history, the patient mentions two previous hospital admissions for similar problems. She has received multiple blood transfusions, two colonoscopies, two upper gastrointestinal endoscopies, and a negative gastrointestinal bleeding scan.

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