A premenopausal woman with abdominal discomfort and iron deficiency anaemia

A 48 year old premenopausal woman presented to our clinic with a 12 month history of intermittent abdominal discomfort associated with bloating, constipation, and weight loss of 6.3 kg. Her medical history included chronic iron deficiency anaemia, vitamin D deficiency, and episodes of fresh rectal bleeding caused by haemorrhoids, which required sclerotherapy. She had undergone a diagnostic laparoscopy for abdominal pains, which did not detect any abnormalities. There was no family history of colorectal cancer. On examination she looked well, weighed 50 kg, with a body mass index of 20. Her abdomen was soft, non-tender, and without palpable masses. The results of a digital rectal examination were normal. Routine blood tests showed iron deficiency anaemia, with haemoglobin 109 g/L (reference range 117-155), mean corpuscular volume 80.6 fL (80-100), mean corpuscular haemoglobin 27.3 pg/cell (27-33), and ferritin 4 ng/mL (10-232)