A 74-year-old man presented following an episode of severe rectal bleeding. He was normally fit and well and had had no previous problems with his bowels.
On examination, he was pale. His pulse was 110 beats per minute and his blood pressure was 100/60 mmHg. Abdominal examination was normal. Rectal examination showed fresh blood on the glove.
haemoglobin 85 g/L (130–180)
white cell count 7.5 × 109/L (4.0–11.0)
What is the most likely diagnosis?
A: bleeding diverticulum
B: carcinoma of colon
C: colonic polyp
E: inflammatory bowel disease
Correct answer: A Explanation The most common cause of such heavy bleeding in a 74-year-old is diverticular disease related. It is very unusual for cancer and polyps to bleed so heavily and there often is a preceding history of bleeding. Likewise, haemorrhoidal bleeding rarely causes haemodynamic instability. Inflammatory bowel disease very unusually leads to such heavy bleeding and there will often be a preceding history of symptoms.