General Surgery – Melena and Hematochezia: The Daily PANCE Blueprint

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General Surgery - Melena and Hematochezia: The Daily PANCE Blueprint

A 70-year-old individual presents to your office with a history of melena and one episode of bright red blood per rectum. The patient has a history of chronic NSAID use for osteoarthritis and a previous peptic ulcer. Physical examination is unremarkable, and vital signs are stable. Laboratory tests reveal a mild decrease in hemoglobin. Upper endoscopy is negative, and colonoscopy reveals diverticula in the descending colon but no active bleeding. What is the most appropriate next step in the management of this patient?

A. Angiography
B. Surgical Resection of Diverticula
C. CT Scan of the Abdomen and Pelvis
D. Capsule Endoscopy
E. Prescribe Proton Pump Inhibitors (PPIs)

Answer and topic summary

The answer is D. Capsule Endoscopy

Given the patient’s presentation with melena and hematochezia, negative upper endoscopy, and colonoscopy revealing diverticula without active bleeding, the most appropriate next step is capsule endoscopy. Capsule endoscopy can help visualize the small intestine, an area not easily reached by traditional endoscopy, and may identify a source of bleeding, such as an arteriovenous malformation or small bowel tumor.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ General Surgery Rotation ⇒ General Surgery: Gastrointestinal and Nutritional ⇒ Melena and hematochezia

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