A lower gastrointestinal bleeding in a haemodialysis patient as a potential precursor of small bowel ischaemia

A 77-year-old man presented with anorexia, nausea, vomiting and bloody diarrhoea. The patient had a past medical history of heart transplantation, multiple myeloma and chronic kidney disease (CKD) requiring haemodialysis. Clinical examination revealed a diffusely tender abdomen. His vital signs included a low blood pressure of 80/55 mmHg, tachycardia of 112 bpm, normothermia (36.2°C) and a SpO2 of 97% when breathing room air. Laboratory studies were significant for haemoglobin 13 g/dL (16 g/dL a few days earlier), CRP 179,8 mg/L, leukocyte count 13,75 x10E3/μL, lactate 4,46 mmol/L and known CKD. A multiphasic contrast-enhanced abdominal computed tomography did not show any acute pathology, nor vascular contrast extravasation.