Massive bleeding per rectum in a 70 years old patient is due to:
**Core Concept**
Rectal bleeding in the elderly is a common symptom that can be caused by various factors, including vascular malformations, diverticulosis, and malignancies. The most common cause of massive bleeding in this age group is diverticulosis, which is a condition characterized by the formation of diverticula (outpouchings) in the wall of the colon.
**Why the Correct Answer is Right**
Diverticulosis is a common condition in the elderly, affecting up to 60% of individuals over the age of 80. The diverticula are most commonly found in the sigmoid colon, and bleeding is thought to occur when a diverticulum erodes into a nearby blood vessel. This can lead to massive bleeding, which can be life-threatening if not promptly treated. The bleeding is usually painless and can be heavy, leading to significant hemodynamic instability.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because while vascular malformations can cause rectal bleeding, they are less common in the elderly and typically present with more gradual onset of symptoms.
**Option B:** This option is incorrect because while malignancies can cause rectal bleeding, they are less common in the elderly and typically present with other symptoms such as weight loss and changes in bowel habits.
**Option C:** This option is incorrect because while rectal ulcers can cause bleeding, they are less common in the elderly and typically present with more gradual onset of symptoms.
**Clinical Pearl / High-Yield Fact**
A key clinical pearl is that massive rectal bleeding in the elderly is a medical emergency that requires prompt evaluation and treatment to prevent hemodynamic instability and death. A high-yield fact is that the most common cause of massive bleeding in this age group is diverticulosis, which can be diagnosed with a colonoscopy and treated with endoscopic removal of the bleeding diverticulum.
**Correct Answer: D. Diverticulosis**