Acute gastrointestinal bleeding with suspected cause of colon diverticular disease

Abstract

Context: Acute gastrointestinal (GI) bleeding is a common condition with diverse etiologies. Determining the cause and location of bleeding can sometimes be challenging. A holistic understanding of conditions and causes combined with detailed patient information, examination and tests findings, could enable approach for appropriate diagnosis, management, and treatment. Case report: A 85 year-old man, often constipated in history, having a habit of eating few vegetables, was admitted to the hospital because of fatigue and dizziness after several episodes of tarry bowel movements in the month before going to hospital. The patient had undergone previously gastroscopy, colonoscopy, capsule endoscopy and abdominal CT scanner. At admisson, the patient had black, viscous and pungent stools continuously from the previous 3 days. Patient had stable hemodynamic state and vital signs with heart rate 70 beats/min, blood pressure 110/70 mmHg, temperature 36.5^o C. Clinical examination noted marked tiredness and pale mucosa. Complete blood count (urgently done) showed RBC 1.5 T/l, HGB 44 g/l, HCT 0.132 l/l. He was then diagnosed acute gastrointestinal bleeding, severe chronic anemia with colonic diverticular disease (diverticulitis, diverticular bleeding) as suspected cause. The patient received fluid infusion, blood transfusion, antibiotic treatment (metronidazole 1.5 g/day), underwent the oesogastroscopy and abdominal CT. The clinical condition improved after 5 days under treatment and the patient was discharged on the 11th day in stable state. Conclusions: Acute gastrointestinal bleeding needs a systematic approach, emergency management and appropriate symptomatic and cause-oriented treatment according to evidenced-based guidelines.