Bleeding hemorrhoids - importance of coverage in CT mesenteric angiography
Diagnosis certain
Presentation
Multiple episodes of brisk rectal bleeding. Now hypotensive. Hemoglobin of 5 g/dL (N range 13.8 to 18.0)!! Past history of hemorrhoids.
Patient Data
Age: 75 years
Gender: Male
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The rectum and sigmoid are distended with blood. Contrast extravasation detected in the distal rectum and anus indicative of active bleeding.
Case Discussion
Surgeons found bleeding hemorrhoids on sigmoidoscopy. These abnormal veins in the rectal wall were not visible.
It is surprising to me (at least) that bleeding from hemorrhoids can be so severe and not clinically obvious to the treating doctors. What that means to the prescribing radiologist and radiographers is the entire gastrointestinal tract from stomach to anus must be included in the scan range.
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