21st July 2023

A 24-year-old woman presents to the emergency department with an episode of PR bleeding on defecation

A 24-year-old woman presents to the emergency department with an episode of PR bleeding on defecation. She is worried about the bleeding as her father passed away from colorectal cancer aged 49. She reports intermittent constipation associated with right-sided abdominal pain but no other GI symptoms. She also reports a 1-year history of left-sided jaw pain that is worse at night but improves with ibuprofen. Examination of her abdomen, heart, lungs and CNS are normal. PR exam reveals some fresh blood but no palpable masses. There is a firm irregular non tender mass on her left mandible. She also has 4 fatty egg-shaped lumps on her upper back and arms, measuring 3-6cm in diameter, which she says have been present for many years.

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