A 41-year-old man came to the emergency department with several days of bloody diarrhea. His symptoms began 3 days prior with worsening lower abdominal cramping and fecal urgency. This progressed to frank bloody diarrhea with a bowel movement every 1 to 3 hours. He had taken his temperature at home, with a maximum of 100.4°F that resolved within minutes without intervention. He had no chills, night sweats, or weight changes. He denied recent antibiotic use, travel, and sick contacts. His only recent water exposure was visiting a local water park about 2 weeks previously. His only medication was loperamide, which he had started using sparingly to treat his diarrhea. Social history was negative for tobacco use, and he used alcohol only rarely. His family history was significant only for diverticulosis in his mother.
Clinical and Laboratory examination
Physical examination revealed a blood pressure of 104/74 mm Hg, heart rate of 82 beats/min, respiratory rate of 12 breaths/min, temperature of 37.2°C, and oxygen saturation of 98%. Abdominal examination revealed bilateral lower quadrant tenderness, normoactive bowel sounds, and no peritoneal signs. Rectal examination revealed no hemorrhoids or masses and minimal red stool in the rectal vault. Laboratory studies revealed the following (reference ranges provided parenthetically): hemoglobin, 14.4 g/dL; white blood cell count, 8.5 × 109 cells/L; platelet count, 197 × 109 cells/L; creatinine, 1.09 mg/dL; and fecal hemoglobin, positive.
Which one of the following is the most likely cause of this patient’s symptoms?
a. Colorectal cancer
c. Infectious colitis
d. Inflammatory bowel disease
e. Ischemic bowel disease
The answer to be disclosed shortly!
Source: Mayo clinic