The most common cause of bright red blood in stool is bleeding from the hemorrhoids. The bleeding is generally minimal, painless and self limiting.
However, I have recently come across few cases where the bleeding is quite profound needing multiple units of blood transfusion.
I was recently asked to see a pleasant 88 year old man who had been experiencing large amount of blood in stool – red, dark and with clots. He was transfused a total of 5 units of PRBC. Upper endoscopic examination was unremarkable. Colonoscopy had revealed single diverticulum, otherwise no bleeding. Multiple areas of clotted old blood noted at the anal verge. The bleeding had quit and he was discharged home.
He presented again with intermittent rectal bleeding, RBC tagged scan was negative. This admission a total of 4 units of blood were transfused. Repeat colonoscopy revealed a bleeding vessel at the anal verge adjacent to dark clotted area. To control 1 cc of Epinephrine 1:10,000 was injected at the base followed by a resolution clip at the base of the vessel.
This is my first experience with use of clip to control bleeding from a hemorrhoidal vessel.