22nd July 2023

A 70-year-old man is brought into resus in the emergency department with a 2-hour history of continuous heavy fresh red PR bleeding

A 70-year-old man is brought into resus in the emergency department with a 2-hour history of continuous heavy fresh red PR bleeding associated with dizziness and reduced conscious level. His partner reveals that over the last year he has had PR bleeding twice a month on defecation, which has always self-resolved. He has a history of end stage renal failure requiring dialysis and type 2 diabetes mellitus. He is a non-smoker and drinks 3 units of alcohol weekly. On examination, he is pale and cool peripherally. His chest, heart and abdominal examinations are normal. PR exam reveals fresh red blood but no palpable masses. Observations: HR 130 bpm and regular, BP 98/56 mmHg, RR 22, oxygen saturation 96% on room air and temperature 37.2°C. His blood tests reveal an iron deficiency anaemia with a haemoglobin of 62, acute kidney injury (AKI) on CKD and a raised serum lactate. Following resuscitation, emergency colonoscopy is attempted, however, there is poor visualisation due to acute bleeding.

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