Case History:
We present a 43-year-old male with a past medical history of
hypertension, dyslipidemia, benign prostate hyperplasia, and internal
hemorrhoids who presented to the emergency department (ED) for two
episodes of bright red blood per rectum. He initially attributed his
bleeding to his hemorrhoids. While in the ED, the patient had two
further episodes of large bright red blood per rectum. He did not report
any abdominal tenderness. In the ED, his vitals revealed a temperature
of 36.8 C, heart rate of 99 beats per minute, blood pressure of 115/ 85
mmHg, and oxygen saturation of 97% on room air. His physical exam was
benign except for bright red blood per rectum. Labs were notable for a
hemoglobin of 11.8 g/dL and lactic acid of 2.9 mmol/L. CT angiography of
the abdomen and pelvis was performed, which did not show any active
gastrointestinal hemorrhage. The patient was started on Protonix 80 mg
IV and 2 IV fluid boluses. The patient was admitted to the medical floor
for treatment. GI was consulted, and the patient was scheduled for a
colonoscopy.