Question

A 65-year-old man with a long history of constipation presents with bright red blood per rectum for 1 day. He denies any straining, abdominal pain, diarrhea, or lightheadedness. He denies any recent trauma and family history is unremarkable. His last colonoscopy was about 12 years ago and patient reports he had some "blebs" in his colon. Physical exam was largely unremarkable and a rectal exam did not show any perianal fissures or hemorrhoids. Stool hemocult test is positive. What is the diagnosis?

Answer 1

The patient's symptoms, history, and positive fecal occult blood test suggest colorectal cancer as a significant possible diagnosis, particularly considering the presence of polyps in the past. A prompt follow-up colonoscopy is necessary for definitive diagnosis and potential polyp removal.

Step-by-step explanation:

A 65-year-old man presents with a history of constipation and bright red blood per rectum without any associated symptoms such as straining, abdominal pain, or lightheadedness. While physical and rectal exams seem unremarkable, a positive stool hemocult test indicates the presence of occult blood in the stool. Given the history, age, symptoms, and the fact that his last colonoscopy was 12 years ago, a significant differential diagnosis to consider would be colorectal cancer. While other causes such as infectious colitis, ischemic colitis, or inflammatory bowel disease (like ulcerative colitis) could cause similar symptoms, the absence of other systemic signs and symptoms reduces their likelihood. The patient's description of "blebs" potentially refers to polyps, benign growths in the colon that can transform into cancerous lesions over time. Therefore, a follow-up colonoscopy is crucial for diagnosis and potential therapeutic intervention.