// // // //

Case 70: PR bleeding

A 62 year old woman had been becoming tired lately. Her local doctor noticed she was anaemic, with a microcytosis consistent with iron deficiency. She had noticed a change in her usual bowel habit and some blood in her bowel motion recently.

1.What are the two abnormalities?

Significant blood coating the rectal mucosa. There is also a small rectal polyp at the 1 O'Clock position. This small volume colonic bleeding, which has this characteristic colour, usually heralds a significant colonic cancer more proximally.

2.Do you think it explains the blood in the lumen?

Probably not, the lesion, as visualised, has no demonstrable bleeding. It is however of a significant size and has the gross appearance of an adenomatous lesion.

3.Describe the lesion

There is a circumferntial stenosing lesion which narrows the colonic lumen. It is irregular, craggy, with a small lumen centrally, also deep inside this lumen can be seen a small bleeding area. The lesion also has evidence of a mucous discharge over its surface.

4.What are the options for confirming that the remainder of the colon is clear of polyps or synchronous tumours?

1.Barium enema
2.CT colonography
3.MR colonography
4.Ontable colonic washout and colonoscopy (antegrade or retrograde)
5.Less sensitive is palpation at laparotomy.

Further Information

Powerpoint Presentations