Explosive blood clot in feces/one time- what can it be?

[gamy]

I am 54 yrs, female. First, had a sigmoidoscopy in '96, because of bowel problems. GI found a polyp and removed, it was benign. Bowel problems resolved. Dr. did not feel bowel problems were related to polyp, but more from IBS. Did not have problems until three months ago. Had a colonoscopy in '02, because I was over 50 yrs., and that was recommended. Colonoscopy was normal, except for a small internal hemmoroid, which has not presented me with any problems. Three months ago, I experienced sharp pains for a few minutes in my right lower abdomen. Then I experienced aching in that area with difficulty defecating, lots of gas, but difficulty eliminating. Also with some intermittent dyarhea. Had trans-vag ultrasound and it ruled out ovarian cyst. Had rectal occult for blood, was negative. Had CT scan of abdomen and pelvic area, was normal. Saw my GI Doctor, and he did not see any need to scope and poke as he thought it might have been an immflation of the colon and prescribed Bentyl. After a few weeks, with Bentyl, things seemed to get better, and I thought I was passed that. This was 8 weeks ago. I have to say, I still have a pulling pain on my right side, low in the abdomen, which comes and goes. Sometimes relieved by BM, but can stay all day as well. But what has really concerned me, is 3 days ago, I had a bowel movement, and I passed, what looked like a large blood clot. I wiped myself and saw bright red blood as well. It has not happened again. I did a home test, EZ DETECT today, and it was negative. Now, I am worried about colon cancer. Could colon cancer show up so soon after I had the clear colonoscopy in '02? Could I have had a blood clot in the arteries on the r-side of pelvis, or in the ascending colon, and it passed? I am pretty scared right now. FYI, I don't take any drugs, except for Crestor, 10mg daily, and lots of vitamins. Should I go back to the GI Specialist or what. Thanks

[Kevin Pho, MD]

It is unlikely that colon cancer would pop up that fast with a clean colonoscopy in 2002.  Possible causes in the right lower quadrant would include appendicitis, irritable bowel disease, and inflammatory bowel disease.  With a normal CT of the abdomen, the chances of any appendiceal disease is less likely.  The small bowel sometimes cannot be adequately imaged via endoscopy - a small bowel series sometimes has to be performed to evaluate for Crohn's disease.

If all the tests are negative, then treamtent for irritable bowel disease should be optimized.  If there is "difficulty eliminating" (i.e. constipation), then Zelnorm may be considered.

Regarding the large blood clot - a simple flexible sigmoidoscopy can be considered to look for any anatomical damage.  

You may want to discuss these options with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Jen16]

I am a RN and once had a patient pass a giaganitic blood clot, I'm talking HUGE, it scared the heck out of me but the patient was absolutely fine.  They did a colonoscopy and found absolutely no reason for this giant clot.  Their best guess was that he had a diverticuli which burst.  He did not have any further clots passed nor any other blood in his stool.  It is definately something you need to let your doctor know about but I just wanted to let you know that it might be something other than cancer.

[surgeon]

It's highly unlikely cancer would appear in 2 years after a normal colonoscopy. And cancer would rarely bleed like that. The two most likely possibilities are diverticular disease or hemorrhoids. With the lingering symptoms you describe, diverticulitis is a strong possibility. You ought to let your gastroenterologist know what happened.