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Case 10 

Case 10
Chapter:
Case 10
Author(s):

Alissa J. Walsh

, Otto C. Buchel

, Jane Collier

, and Simon P.L. Travis

DOI:
10.1093/med/9780199557899.003.10
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date: 22 October 2019

A 78-year-old woman from Yorkshire was referred with a 5-year history of diarrhoea that was predominantly nocturnal. Symptoms had worsened over the preceding 12 months. She would have to get up three or four times to open her bowels, on 3 or 4 nights a week. Daytime frequency was only twice, but stools were often explosive, pale and sometimes left a residue after flushing. She had lost 10kg in 2 years, but her appetite was normal. She had been referred 2 years previously and been investigated. A barium enema had shown sigmoid diverticular disease, but no other abnormality. A macrocytic anaemia (Hb 10.8g/dL, MCV of 132fL) had been found, attributable to vitamin B12 deficiency. Her folate was normal, towards the upper limit of the range. Vitamin B12 replacement every 3 months had been started. On examination, she was cachectic and weighed 51kg.

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