A 45-year-old woman with factor 1 deficiency presented to the general surgery clinic with a history of multiple episodes of lower gastrointestinal bleeding. These episodes started approximately 4 years prior, occur approximately every 3 to 4 months, and are associated with crampy abdominal pain. Although she has been hospitalized, she never required a transfusion. Colonoscopies were significant only for diverticulosis without a clear source of bleeding. Her previous abdominal surgery included a hysterectomy for menorrhagia. There is no family history of colon cancer.
Hata KW, Yi F. Repeated Lower Gastrointestinal Bleeding. JAMA Surg. Published online March 15, 2017. doi:10.1001/jamasurg.2017.0038