Case 2

High Index Of Suspicion

A female patient, 65 years old, with a history of lymphoma and treatment by radiotherapy 4 years ago. She also is known to have chronic hepatitis C.

She presented today to the casualty unit shocked with severe attacks of bleeding per rectum also had bluish discolored pulseless four limbs. What is the approach to this case? and what is the question you want to ask?

As regard the bleeding per-rectum or even bloody diarrhea, one must not take it lightly as it may denote a serious vascular problem if put in the right context. So as in this case it is considered to be a sign of ischemic colitis if it put in the context of other vascular affection evidenced by the bluish pulseless limbs and shock..