Case Study 26092016

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26 Sep 2016 - General

An elderly gentleman, with background of previous stroke, hypertension, type 2 diabetes mellitus, history of prostate cancer (received external beam radiation last year), and depression, presented to casualty due to 1 month history of intermittent fresh per rectum bleeding. Patient denied any constipation or diarrhoea or any weight loss. He has no abdominal pain. The only symptom was fresh PR bleeding intermittently, can be up to 5-6 episodes per days. His HB was dropped to around 8.5 g/dl, comparing to was around 11.5 g/dl around 6 months ago. No other abnormality in other blood test, with normal renal function , liver function and CRP. What will be your differential diagnosis for his symptom ?? What is the investigation of choice and the management plan ??

Yes, Jennifer Winter , Radiation Proctitis is the most likely diagnosis. The investigation choice will be colonoscopy (if patient is clinically fit for the procedure, if not, then flexi-sigmoidoscopy can be 1st step of investigation). CT scan may be considered at a later stage if uncertainty in the diagnosis. I would agree that patient should not be receiving blood product at this stage. Patient should be given i...
 (Total 120 words)
Given his history of beam radiation from last year despite the lack of bowel changes I would consider the possibility of radiation injury namely Radiation Proctitis. I would order for a CT scan but for a more definitive diagnosis I would want a colonoscopy done depending although on the friability of the colon. Manage patient with fluid replacement. Despite drop of hemoglobin I wouldn't recommend blood transfusion as of now but get the patient typed and cross matched as surgical intervention...
 (Total 89 words)