A 68-year-old male presents to the emergency department with a complaint of bright red blood per rectum. He has had several episodes of hematochezia, beginning on the evening before presentation. He describes the bleeding as profuse and filling the toilet. On the morning of presentation the patient felt light-headed and almost passed out while sitting on the toilet. He has a past medical history of hypertension. He normally takes amlodipine for hypertension but did not take it because of these symptoms. On physical examination the patient appears pale. Blood pressure is 86/42, and heart rate is 134. He is unable to stand for orthostatic vital signs. Abdominal examination reveals slight abdominal distention with hyperactive bowel sounds. He has gross blood in the rectal vault. Initially, the patient undergoes volume resuscitation with normal saline and receives 3 units of packed red blood cells. Blood pressure increases to 110/56 and heart rate decreases to 100 with these interventions. Initial hemoglobin is 7.2 mg/dL, and this rises to 9.8 mg /dL after transfusion. The patient is transferred to the medical intensive care unit, where he subsequently undergoes a radionucleotide localization scan that reveals a bleeding source in the right colon. What would be the most appropriate next step in this patients management? A. CT scan of the abdomen with intravenous contrast B. Selective mesenteric angiogram with coiling C. Colonoscopy D. Total abdominal colectomy E. Partial colectomy
Posted on: Sat, 10 Jan 2015 22:03:32 +0000
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