A 70-year-old woman presents with a complaint of a large, bloody bowel movement. Earlier during the day, she passed a large quantity of blood while defecating. She had no nausea, vomiting, abdominal pain, tarry stool, or light-headedness. Examination : She appeared pale in ER, but she was alert and talkative. Her pulse was 110/min and regular. The examination of the abdomen revealed normal active bowel sounds and no tenderness, masses, or organomegaly. The rectal exam revealed large external hemorrhoids but no masses.
The stool was bloody. The hematocrit was 27%, WBC was 10,500 cells/mm3 without a left shift. Platelets were 347,000/mm3. Prothrombin time was 10.2 seconds. BUN and creatinine were 12 mg/dL and 0.6 mg/dL, respectively. The initial workup was negative for a specific bleeding site. During hospitalization, the stool was negative for blood; however, she passed a bloody…
