He noted the onset of hematemesis after violent retching. For several days prior to admission, he has noted stools to be somewhat looser than normal as well as dark in color. Two hours befor coming to the emergency room, he began passing bright red blood per rectum. He has had no previous hospitalizations for abdominal pain but was diagnosed as having diverticular disease after a barium enema in 1982. Physical examination reveals a slightly overweight, white male, somewhat pale in color.
Orthostatic changes are rooted.
The abdomen is soft and non-tender with no abdominal masses. Bowel sounds are increased. Rectal exam reveals bright red blood in the rectal vault. Diagnostic studies include a chest x-ray and abdominal series that are read as normal. Hemoglobin is 12, hematocrit 31, PT and PTT normal.