Acute Colitis with Bloody Diarrhea in Young Woman with Family History of Colorectal Cancer

Case at a Glance

A 34-year-old female with family history of colorectal cancer presented to the emergency department with acute onset of bloody diarrhea, abdominal cramping, and CT findings of sigmoid colon thickening after one month of intermittent abdominal pain.

Patient's Story

The patient experienced approximately one month of intermittent lower abdominal and pelvic pain that was initially difficult to characterize as gastrointestinal or gynecologic in origin. While on a family outing, she developed sudden severe abdominal cramping accompanied by profuse sweating and pallor, necessitating immediate return home. Initial bowel movements were diarrheal without blood, but subsequent episodes revealed blood and possible mucus in the stool. She experienced nocturnal cramping at 2:00 AM with continued bloody diarrhea, prompting her to seek emergency care.

Initial Assessment

34-year-old female, BMI 30.6 (180 lbs, 5'4"), non-smoker, non-drinker. Past medical history significant for benign colonic polyps found on colonoscopy two years prior, which was otherwise normal. Recent diagnosis of lichen sclerosus three days before current presentation. Family history notable for father's death from colon cancer two years ago. Patient has chronic hemorrhoids since childbirth.

The Diagnostic Journey

Emergency department evaluation included complete blood work, which was within normal limits. CT scan of the abdomen and pelvis revealed mild thickening of the descending and sigmoid colon, described as 'compatible with underdistention or colitis in the appropriate clinical setting.' The emergency physician did not favor a diagnosis of colitis based on clinical presentation but recommended gastroenterology follow-up for further evaluation including possible repeat colonoscopy.

Final Diagnosis

Acute colitis with sigmoid colon involvement, etiology to be determined. Differential diagnosis includes inflammatory bowel disease, infectious colitis, or other inflammatory conditions. Colorectal malignancy considered less likely given recent normal colonoscopy, though follow-up required.

Treatment Plan

Patient advised to follow up with gastroenterology for definitive diagnosis and management. Repeat colonoscopy recommended to evaluate colon thickening and rule out underlying pathology. Given family history of colorectal cancer, close monitoring and appropriate screening intervals to be established.

Outcome and Follow-up

Patient discharged from emergency department with gastroenterology referral. Symptoms of acute bloody diarrhea and cramping noted at time of discharge. Patient counseled regarding concerning symptoms requiring immediate return to medical care. Follow-up colonoscopy pending to determine underlying etiology of colonic thickening and guide appropriate treatment.