Recurrent Gastrointestinal Bleeding with Mixed Blood Pattern in a Young Adult
Case at a Glance
A 25-year-old male with known hemorrhoids presents with intermittent episodes of mixed gastrointestinal bleeding, including both melena and hematochezia, accompanied by mild abdominal discomfort and anxiety regarding potential malignancy.
Patient's Story
The patient reported infrequent episodes of tarry, dark stools accompanied by bright red blood. On the day of presentation, he experienced similar symptoms along with mild abdominal discomfort that resolved after defecation and fluid intake. The patient has a documented anxiety disorder and expressed significant concern about colorectal cancer, particularly referencing a public figure who died of the disease at a young age. He has known hemorrhoids and reported recent changes in bowel frequency from once daily to twice daily. Family history is notable for diabetes and paternal grandfather's death from smoking-related lung cancer, with no known family history of colorectal malignancy.
Initial Assessment
Physical examination findings were not documented in detail. The patient reported subsequent bowel movements showed normal brown stool with some mucus and possible orange-tinged liquid. He described the abdominal sensation as more of an ache than sharp pain. The patient's parents provided reassurance, relating similar experiences in their own medical history with negative workups.
The Diagnostic Journey
Initial concern focused on ruling out serious pathology given the mixed bleeding pattern. The combination of melena and hematochezia in a young patient raised questions about bleeding source location. Differential diagnosis included hemorrhoidal bleeding, inflammatory bowel disease, polyps, or less likely malignancy given the patient's age and family history. The patient initially considered emergency evaluation but ultimately decided on outpatient follow-up after family consultation.
Final Diagnosis
Likely hemorrhoidal bleeding with possible dietary contribution, though definitive source of bleeding requires further investigation with colonoscopy for complete evaluation.
Treatment Plan
Outpatient gastroenterology referral for colonoscopy to definitively identify bleeding source. Primary care physician consultation recommended for initial evaluation and appropriate referral. Patient counseled that emergency department evaluation unlikely to provide immediate definitive diagnosis without colonoscopic examination.
Outcome and Follow-up
Patient's anxiety decreased after family discussion and reassurance. He elected to monitor symptoms for several days before scheduling routine medical evaluation. Emphasized importance of gastroenterology consultation rather than emergency evaluation for non-acute presentation. Patient advised to seek immediate care if symptoms worsen or if heavy bleeding occurs.