Patient is 24, female with PCOS who has presented wirh abdominal pain and has ma

Management and investigation of a 24-year-old female with PCOS presenting with abdominal pain and maroon blood in stool:

• Given the presentation of abdominal pain with rectal bleeding (maroon blood), colorectal pathology including cancer must be considered, even in adults under 50 years.

• Offer quantitative faecal immunochemical testing (FIT) to assess for colorectal cancer or other significant colorectal disease as first-line investigation in primary care.

• If FIT is positive or if there are other concerning features (such as a palpable abdominal or rectal mass), refer urgently via the suspected cancer pathway for colorectal cancer.

• Perform a thorough abdominal and rectal examination to identify any masses or organomegaly.

• Consider other causes of abdominal pain and rectal bleeding such as inflammatory bowel disease, haemorrhoids, or anal fissures, but do not delay cancer investigation if suspicion is raised.

• In the context of PCOS, assess for risk factors that may increase cancer risk, particularly endometrial cancer, but this is less likely to cause maroon rectal bleeding.

• Manage PCOS according to guidelines, including lifestyle advice and screening for metabolic complications, but this does not directly address the acute presentation.

Summary: In this patient, urgent investigation of the rectal bleeding and abdominal pain with FIT and possible referral for colonoscopy is appropriate to exclude colorectal cancer or other serious pathology. PCOS management should continue as per standard care but does not alter the acute investigation pathway for rectal bleeding.

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