Question

A 52-year-old Caucasian woman presents with a 2-week history of rectal bleeding. Over the last 3 months, she has become progressively more tired, and could no longer play tennis on weekends. She denies diarrhea, abdominal pain or tenesmus. Her past medical history includes peptic ulcer disease 5 years ago, treated with an anti-H.pylori scheme and which has not recurred.

Her vital signs are stable, and the physical examination shows no abnormalities.

A CBC shows the following:

Ht: 28%
Hb: 8.8 mg/dl
MCV: 82 fl
Leukocytes: 8.100/mm3 w/ normal differential
An upper endoscopy is normal except for a duodenal ulcer scar without signs of active ulceration, and a repeat colonoscopy is normal.

What is most likely to identify the source of bleeding?

Celiac angiography
Highlight Strikethrough 2 Computed tomography of the abdomen
Highlight Strikethrough 3 Wireless capsule endoscopy
Highlight Strikethrough 4 Push enteroscopy
Highlight Strikethrough 5 Biopsy of the healed ulcer bed
Highlight Strikethrough 6 99mTc scan
Highlight Strikethrough 7 Small bowel follow-through99mTc scan

Answer 1

The most likely method to identify the source of bleeding in a woman with a history of peptic ulcer disease, but with normal endoscopy and colonoscopy results, is a wireless capsule endoscopy.

Step-by-step explanation:

A 52-year-old Caucasian woman with a history of peptic ulcer disease presents with rectal bleeding and chronic fatigue. Despite having a normal upper endoscopy and repeat colonoscopy, the source of bleeding remains unidentified.

Considering the limitations of endoscopy and colonoscopy in detecting small intestinal lesions and the woman's anemic status, a wireless capsule endoscopy would be most likely to identify the source of bleeding. This non-invasive procedure allows for a comprehensive examination of the entire small intestine, which might reveal lesions like angioectasias, small ulcers, or tumors not seen on traditional endoscopy or colonoscopy.