Differential Diagnosis for Profuse, Massive PR Bleeding
- Single most likely diagnosis
- Diverticulitis: This condition is a common cause of massive lower gastrointestinal bleeding, especially in adults over 40 years old. The presence of a hyperemic and reddish area in the transverse colon during colonoscopy supports this diagnosis, as diverticulitis can cause inflammation and bleeding in the colon.
- Other Likely diagnoses
- Crohn’s disease: This is an inflammatory bowel disease that can cause bleeding, diarrhea, and abdominal pain. While it's less likely to cause massive bleeding compared to diverticulitis, it's still a possible diagnosis, especially if the patient has a history of Crohn's disease.
- UC (Ulcerative Colitis): Another type of inflammatory bowel disease, UC can cause rectal bleeding, diarrhea, and abdominal pain. Like Crohn's disease, it's less likely to cause massive bleeding but should be considered in the differential diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Aortoenteric fistula: This is a rare but life-threatening condition where there's a connection between the aorta and the intestine, leading to massive bleeding. Although it's less common, it's crucial to consider this diagnosis due to its high mortality rate if left untreated.
- Rare diagnoses
- Other rare causes of massive lower gastrointestinal bleeding, such as vascular ectasias, colon cancer, or Dieulafoy's lesion, should also be considered, although they are less likely than the above diagnoses.