A 76-year-old man presents to the emergency department with a 6-hour history of passing large volumes of bright red blood per rectum. He feels lightheaded and fainted once at home. His past medical history includes hypertension, atrial fibrillation (for which he takes apixaban), and diverticulosis noted on a previous colonoscopy.
On examination, he is pale and diaphoretic. His blood pressure is 88/55 mmHg, pulse is 115 bpm, and he has cool peripheries. Digital rectal examination confirms the presence of bright red blood with clots. Laboratory investigations show a hemoglobin of 12.3 g/dL, normal platelet count, INR of 1.2, and a blood urea nitrogen (BUN) to creatinine ratio of 15:1.
Two large-bore IV cannulas are inserted, and the patient is resuscitated with IV fluids. The gastroenterology team is consulted urgently.
What is the most appropriate next diagnostic investigation?
Keep going — a set of ten like this one, one at a time.
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