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A 64-year-old man has been having bloody bowel movements for 2 days. He reports to the emergency department, and while waiting to be seen he has another large evacuation of dark red blood. His blood pressure is 90/70 mm Hg and pulse is 110/min. He has a hemoglobin level of 9 mg/dL. In the initial evaluation a nasogastric tube is inserted and aspiration produces clear, green fluid without blood. Digital rectal examination and anoscopy show that there is blood in the rectal vault, but does not identify a source. Which of the following is the most appropriate diagnostic study at this time?
A.
Colonoscopy
B.
Barium enema
C.
Tagged red-cell study
D.
Upper gastrointestinal barium studies
E.
Upper gastrointestinal endoscopy
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ccc
colonoscopy has the risk of perforation if the blding is due to diverticulosis
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quansar ,can u explain please
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The correct answer is C
The clear aspirate at a time when he is actively bleeding indicates a source distal to the ligament of Treitz. Colon is the most likely site, but it could be small bowel. Tagged red-cell study should provide an idea of the region where the blood is pooling and set the stage for an arteriogram if active extravasation is demonstrated.
Colonoscopy (choice A) might appeal to some, but as a rule endoscopy of the colon at
the time of active bleeding is unrewarding because the blood comes from higher up,
obscuring the view as the instrument is advanced.
Barium studies, either from above (choice D) or below (choice B), are contraindicated
at the time of active bleeding. Barium gets in the way of other, more productive studies.
The upper gastrointestinal is not the source of bleeding, and thus endoscopy of that area
(choice E) will not help
