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JAMA Surgery Clinical Challenge
May 2017

Repeated Lower Gastrointestinal Bleeding

Author Affiliations
  • 1San Antonio Military Medical Center, Joint Base San Antonio–Ft Sam Houston, Ft Sam Houston, Texas
JAMA Surg. 2017;152(5):499-500. doi:10.1001/jamasurg.2017.0038

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.

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