CASE REPORT: А rare cause of lower gastrointestinal bleeding

A 72-year-old man presented with lower gastrointestinal bleeding, abdominal pain, microcytic hypochromic anaemia – haemoglobin 96g/L. The bleeding started the previous day with 5-6 loose bloody stools.

Medical history includes DM type2, diabetic polyneuropathy, IHD with implantion of a coronary stent few years prior for which he takes Clopidogrel 75mg, bilateral gonarthrosis – history of Diclofenac usage for years. No history of inflammatory bowel disease, diverticulosis or colon cancer.

During admission patient passed 2 massive bloody stools. Urgent gastroscopy was performed – Forrest III duodenal ulcer was found with no stigmata of recent bleeding. Because a source of bleeding wasn’t found it was decided to perform urgent colonoscopy without previous preparation. Colonoscopy was done to right flexure where circular stenosis was found unable to pass through it along with ulcers with uneven shape and active bleeding extending to the left flexure, diverticulosis of colon sigmoideum without SCAD – ischemic colitis was observed. CT angiography was performed ruling out abdominal ischemia. Conservative treatment was started – antibiotics, LMWH, PPI, blood transfusion and cessation of NSAID. Patient was haemodinamically stable during the whole hospital stay. Mesalazine 3000mg was given per os after discharge. Patient was admitted again month later for subsequent colonoscopy. Haemoglobin was 126g/L. Three diaphragm strictures were found in colon transversum and right flexure – the last one couldn’t be passed again with colonoscopy with standard colonoscope. NSAID-induced colopathy diagnosis was accepted [1] [2] [3].

Publication History

Article published online:
27 March 2025

• References

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