Differential Diagnosis for Rectal Bleeding in a 25-year-old Male Patient
Single Most Likely Diagnosis
- Anal Fissure: Given the patient's history of a previously diagnosed and treated anal fissure, which required stitching, it is likely that the current symptoms could be related to a new or recurrent fissure. The patient's symptoms of bleeding upon wiping after defecation are consistent with this diagnosis.
Other Likely Diagnoses
- Hemorrhoids: These are common causes of rectal bleeding, especially in individuals with a history of straining during bowel movements or constipation. The patient's previous surgery and potential for altered bowel habits could increase the risk.
- Proctitis: Inflammation of the rectum could cause bleeding, and given the patient's history of having a large portion of their intestine removed, they might be at higher risk for complications such as inflammation or infection in the remaining rectal tissue.
Do Not Miss Diagnoses
- Colorectal Cancer: Although rare in young individuals, a history of significant intestinal surgery and potential chronic inflammation could increase the risk. It's crucial to rule out cancer due to its severe implications.
- Infectious Colitis: Given the patient's history of C-diff infection, there's a possibility of recurrent or new infections, especially in an immunocompromised state or with altered gut anatomy.
- Gastrointestinal Bleeding from Remaining Intestine: The patient's history of large intestine removal could lead to complications such as bleeding from the remaining intestine or anastomotic sites.
Rare Diagnoses
- Intussusception: A condition where a part of the intestine slides into an adjacent part, which could cause bleeding. This is more common in children but can occur in adults, especially with a history of intestinal surgery.
- Angiodysplasia: Vascular malformations in the gut that can cause bleeding. This condition is rare and more commonly associated with older adults, but could be considered in the differential given the patient's complex medical history.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could cause rectal bleeding. Although the patient's history does not strongly suggest IBD, it remains a possibility, especially if there are symptoms of chronic inflammation or if the patient has not been thoroughly evaluated for these conditions.