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Case 102: Blood and mucus per rectum

A 47 year old man presents with 6 weeks of pregressive bloody diarrhoea and passage of mucus per rectum. He now has left sided abdominal pain and a temperature of 37.7C

1. What does the xray show?

The left colon is dilated with "thumb printing" indicating mucosal oedema. This suggests colitis.

2. How would you manage the problem in the emergency department?

Resuscitation and thorough assessment occur simultaneously

3. What features would you look for at colonoscopy to make a diagnosis?

The macroscopic features of colitis are erythema, oedema and a granular appearacne of the mucosa. Contact bleeding and deep ulceration may occur with increasing severity and depending on the underlying aetiology.

Ulcerative colitis occurs in the rectum with confluent spread for a variable distance proximally. Ischaemic colitis involves a segment of bowel, typically around the splenic flexure with normal mucosa adjacent both proximal and distal. In pseudomembranous colitis the "membranes" may be seen as yellow plaques coating a variable amount of the mucosal surface. Crohn's colitis is typified by deep linear ulcers and discontinuous mucosal involvement

Multiple biopsies should be taken from the diseased colon in an effort to confirm the diagnosis.

Further Links ----Colonoscopy Atlas----The DAVE project