Show Summary Details
Page of

Case 10 

Case 10
Case 10

Alissa J. Walsh

, Otto C. Buchel

, Jane Collier

, and Simon P.L. Travis

Page of

PRINTED FROM OXFORD MEDICINE ONLINE ( © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 25 October 2020

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.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.