An Unusual Case of Syncope

CASE REPORTshe was started on inotropic support.The patient also had one seizure-like episode and was transferred to the intensive care unit (ICU). Case DesCriptionAn 83-year-old female with known hypothyroidism and hypertension presented with complaints of a sudden episode of loss of consciousness lasting for 30 minutes with alleged per-rectal bleeding.The patient had a history of weight loss of 12-14 kg in 6 months, had altered bowel movements, generalized weakness, and Bell's palsy 6 years ago.The patient was admitted with the above complaints.The patient had anemia with hemoglobin 7.4 gm/dL and was transfused with one PCV.A gastroenterology referral was sought for the per-rectal bleeding, and sigmoidoscopy was advised.The sigmoidoscopy showed a blood collection of approximately 200-300 mL (Fig. 1).Colonoscopy was advised, and a gastrointestinal surgery referral was sought.Contrast-enhanced computed tomography (CECT) of the abdomen was suggestive of a small diverticulum in the cecum along with minimal fat stranding surrounding the diverticulum along the left lateral wall and base region, likely diverticulitis.Active extravasation of contrast was noted in the cecum with pooling in the venous phase (Fig. 2).Mild atherosclerotic narrowing was noted at the origin of the celiac trunk.An interventional radiology referral was sought in view of this, and embolization was advised.A cardiology referral was sought for bradycardia, and external loop recorder (ELR) monitoring was advised.Two-dimensional echocardiography showed an ejection fraction (EF) of 60%.Magnetic resonance imaging (MRI) of the brain with angiography was suggestive of microbleeds in both cerebral hemispheres and the left cerebellar hemisphere and atherosclerotic plaques in both internal carotid arteries (ICAs) in the carotid canal not causing any luminal narrowing.The patient had four episodes of per-rectal bleeding and went into hypotension with blood pressure 106/60 mm Hg, for which 1-