Question of the week # 294

294) A 71 year old woman presents to the emergency room with complaints of bright red bleeding per rectum. She denies any abdominal pain, nausea or vomiting. She has a history of paroxysmal atrial fibrillation. Her medications include aspirin and beta blocker. About 10 days ago, she had a screening colonoscopy. She had a 3cm polyp in the sigmoid colon which was removed at that time.  She reports that she did not experience any bleeding immediately after polyp removal and is concerned about this episode that occured so many days after the procedure. On physical examination she is afebrile . Abdominal examination is benign. Rectal examination reveals bright red blood and no palpable hemorrhoids. Patient is anxious about her diagnosis.  Which of the following is the most appropriate statement?

A) ” Your bleeding is mostly secondary to ischemic colitis”

B) ” Bleeding can occur up to two weeks after polypectomy”.

C) ” Your bleeding is related to Aspirin use”.

D)  ” We will have to repeat colonoscopy to confirm that a cancer has not been missed”

E) ” You will need diagnostic laporoscopy to evaluate the cause”

8 Responses

  1. Bleeding can occur up to two weeks after polypectomy

  2. B

  3. c

  4. E……The early signs of acute ischemic colitis is abdominal pain, and also abdominal pain and tenderness is common in physical exam, that in this patient is not present. Aspirin will produce bleeding since the begining, after the operation, unlikely 10 days after. And other causes will be a chronic ischemic colitis, most of the times in elderly, but most of the times has abdominal pain. So the anwser is colonoscopy, for any cause of lower abdominal bleeding, and a better treatment. Most of the time treatment is only IV fluid, and bowel rest. Some time antibiotic to preven infection

  5. bbb

  6. dr red pls help……….

    • The concept here is to recognize that Post polypectomy bleeding can occur up until two weeks after polypectomy though most cases present within few hours to 3 days.
      ASA may increase the risk of post polypectomy bleeding in this case however, ASA by itself is NOT the CAUSE of bleeding.

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