68-Year-Old Man with PR Bleed.

A 68-year-old man is referred to the colorectal clinic by his GP. He has lost 10 kg in weight over the last two months. He also noticed that his bowel motions have been loose and sometimes contain blood. You review the full blood count and faecal occult blood test the GP requested. What should you do next?

Request a flexible sigmoidoscopy

Request a colonoscopy

Request a CT pneumocolon

Answers

The correct answer is B

This patient has iron deficiency anaemia associated with a change in bowel habit and blood in the stool. The most important possible diagnosis is carcinoma of the colon. A colonoscope is a flexible camera which can visualise the whole colon. Up to 1.4% per cent of patients with colon cancer have more than one lesion in the bowel (synchronous lesions).

This is why the following answers are incorrect

Flexible sigmoidoscopy would be inadequate as the whole colon needs to be visualized, not just the left hand side.

It is not possible to take biopsies during a CT pneumocolon. An endoscopy would still need to be done to confirm a diagnosis.

Learning Bite

A recent Cochrane review found that faecal occult blood test screening is likely to avoid approximately 1 in 6 colorectal cancer deaths.

Ethical approval

No ethical approval required for this study.

Conflicts of interest

No conflicts of interest have been declared by the author.

Author contributions

SMD

SSD

Funding

No funding source declared by the authors.

Haemoglobin (g/dL)	10.2	(11.5–15.5)
MCV	68	(80–100)
Ferritin (ng/L)	5	(15–300)
Faecal occult blood test:	Positive