A 65-year-old man presented with an episode of syncope. He said he felt dizzy during defecation and noticed gross bleeding in the pan. Fecal occult blood test done 3 months ago as a part of routine screening for colon cancer was negative. There is no history of recent weight loss. What is the likely colonoscopic finding?

Ans. d. Dilated mucosal and submucosal veins in the colon (Ref: Harrison 19/e p731, 18/e p972; Bailey 26/e 1174, 25/e p1157)Diagnosis in a 65-year-old patient of bleeding per rectum with syncope and negative fecal occult blood test and no history of recent weight loss is Heyde's syndrome. The colonoscopic finding in Heyde's syndrome is dilated mucosal and submucosal veins in the colon.Heyde's syndromeHeyde's syndrome is a triad of aortic stenosis, an acquired coagulopathy and anemia due to bleeding from intestinal angiodysplasiaQ.It is due to the induction of von-Willebrand disease type IIA by the valvular stenosisQ.Clinical Features:Gastrointestinal hemorrhage may present as hematemesis, melena, or hematochezia.It is not necessary for the aortic stenosis to lead to any other symptoms, but evidence of heart failure, syncope, or chest pain may be present if the stenosis is severe.Diagnosis:Endoscopy or colonoscopy shows angiodysplasiaQ (Dilated mucosal and submucosal veins).