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Editor’s quiz: GI snapshot
Unusual cause of rectal bleeding in a patient with schizophrenia
  1. Rebecca K Grant1,2,
  2. Charu Chopra3,
  3. Pujit Gandhi4,
  4. Natarajan Manimaran5,
  5. Jonathan T Serhan6,
  6. Kate L Struthers7,
  7. William M Brindle8
  1. 1 Gastrointestinal Unit, Western General Hospital, NHS Lothian, Edinburgh, UK
  2. 2 The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
  3. 3 Department of Immunology, NHS Lothian, Edinburgh, UK
  4. 4 Department of General Adult Psychiatry, Stratheden Hospital, NHS Fife, Cupar, UK
  5. 5 Department of Colorectal Surgery, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  6. 6 Department of Clinical Radiology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  7. 7 Department of Cellular Pathology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  8. 8 Department of Gastroenterology, Victoria Hospital, NHS Fife, Kirkcaldy, UK
  1. Correspondence to Dr Rebecca K Grant, Gastrointestinal Unit, Western General Hospital, NHS Lothian, Edinburgh EH4 2XU, UK; rebecca.grant9{at}nhs.scot

https://doi.org/10.1136/gutjnl-2024-332234

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    Clinical presentation

    A gentleman in his early 40s with a background of schizophrenia on clozapine presented with a 2-month history of rectal bleeding, diarrhoea, weight loss, a microcytic anaemia and a quantitative faecal immunochemical test (qFIT) result >400 µg Hb/g. Colonoscopy demonstrated multiple large polypoid lesions in the rectum and in the sigmoid colon; the sigmoid was unable to be passed by the colonoscope due to narrowing of the lumen (figure 1). Prior to histology being reported, CT colonography was performed to further assess the colon. It reported four malignant-appearing lesions in the rectum and sigmoid with suspicious sigmoid and retroperitoneal lymph nodes (figure 2).

    Figure 1

    Index colonoscopy demonstrating multiple erythematous polypoid lesions causing congestion and narrowing of the lumen throughout the sigmoid colon and rectum: (A) proximal sigmoid (white light endoscopy (WLE)), (B) distal sigmoid (WLE), (C) …

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    Footnotes

    • X @rebeccakg6, @_DrCharu

    • Contributors RKG drafted the original manuscript. CC, PG and NM critically revised the manuscript. JTS provided the radiological images and interpretations. KLS provided the histological image and interpretation. WMB was the senior author and revised the manuscript for important intellectual content. RKG and WMB are the guarantors of this work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.