39-Year-Old Female with Chronic Abdominal Pain and Acute Gastrointestinal Bleeding

Case at a Glance

A 39-year-old female presents with chronic abdominal pain, recent onset of significant rectal bleeding, constitutional symptoms, and concerning gastrointestinal symptoms requiring urgent evaluation.

Patient's Story

The patient reports a lifelong history of abdominal pain that has progressively worsened over recent months. She describes lower abdominal bloating, changes in stool caliber with narrowing, severe fatigue, and postprandial pain. On the day of presentation, she experienced significant rectal bleeding with visible blood in the toilet bowl and active bleeding from the rectum. She also reports chronic orthostatic symptoms including dizziness upon standing and visual disturbances, along with nausea that occurs immediately after eating.

Initial Assessment

The patient appears symptomatic with reported orthostatic symptoms and constitutional complaints. Previous medical evaluations attributed her symptoms to functional dyspepsia and hemorrhoids. A pelvic ultrasound performed several months prior showed no abnormalities. However, the combination of her symptom complex - including chronic abdominal pain, change in bowel habits, constitutional symptoms, and acute significant bleeding - raises concern for underlying gastrointestinal pathology.

The Diagnostic Journey

Previous healthcare encounters resulted in symptomatic treatment with antacids and attribution of symptoms to benign hemorrhoidal disease. The patient's recent relocation has complicated her ability to establish continuity of care with a primary care physician. The acute presentation of significant rectal bleeding with associated systemic symptoms prompted consideration of urgent medical evaluation.

Final Diagnosis

Pending further evaluation - differential diagnosis includes inflammatory bowel disease, colorectal malignancy, severe hemorrhoidal disease with complications, or other gastrointestinal bleeding source. The constellation of symptoms warrants urgent gastroenterology evaluation and likely colonoscopy.

Treatment Plan

Immediate emergency department evaluation recommended given the presence of orthostatic symptoms, significant bleeding, and constitutional symptoms. The patient requires urgent assessment including complete blood count, comprehensive metabolic panel, and consideration for gastroenterology consultation. Long-term management will require establishment of primary care, likely colonoscopy, and systematic evaluation of her chronic gastrointestinal symptoms.

Outcome and Follow-up

Patient advised to seek immediate emergency care rather than urgent care given the severity of symptoms and presence of orthostatic changes. Emergency evaluation will determine need for acute intervention and facilitate appropriate gastroenterology referral for definitive diagnosis and management of underlying condition.