Differential Diagnosis for Profuse Massive PR Bleeding
Single Most Likely Diagnosis
- Diverticulosis: This is the most likely diagnosis given the presentation of profuse massive PR (per rectal) bleeding and the finding of a hyperemic and radish-like area in the transverse colon on colonoscopy. Diverticulosis is a common condition in adults over 40, and it can cause significant bleeding due to the rupture of a diverticulum.
Other Likely Diagnoses
- Crohn's Disease: While less likely than diverticulosis for massive bleeding, Crohn's disease can cause significant gastrointestinal bleeding, especially if there are deep ulcers or a large area of involvement. The hyperemic and radish-like appearance could be consistent with active inflammation.
- Ulcerative Colitis (UC): UC is another form of inflammatory bowel disease that can cause bleeding, though it typically starts in the rectum and extends proximally in a continuous fashion. The description provided does not strongly suggest UC, but it cannot be ruled out without further information on the extent and distribution of the disease.
Do Not Miss Diagnoses
- Aortoenteric Fistula: Although rare and less likely, an aortoenteric fistula is a potentially life-threatening condition that must be considered in the differential diagnosis of gastrointestinal bleeding, especially in patients with a history of abdominal aortic aneurysm repair or other aortic pathology. The presentation can be sudden and catastrophic, making it crucial not to miss this diagnosis.
Rare Diagnoses
- Vascular Malformations or Tumors: These could include conditions like angiodysplasia, Dieulafoy's lesion, or gastrointestinal stromal tumors (GISTs), among others. While rare, they can cause significant bleeding and should be considered if common causes are ruled out.
- Infectious Colitis: Certain infections can cause a hyperemic and potentially bleeding colon, though this would typically be accompanied by other symptoms like diarrhea, fever, and abdominal pain.
- Ischemic Colitis: This condition can cause bleeding and a range of other symptoms depending on the severity and location of the ischemia. It might present with a segment of colon appearing hyperemic or ulcerated.