A 42-Year-Old Man Comes to the Office with Rectal Bleeding

A 42-year-old man comes to the office with rectal bleeding.  He used to have occasional streaks of blood on the tissue after wiping, but for the past several days he has seen blood dripping into the toilet at the end of defecation.  The patient reports chronic constipation and has to strain while having a bowel movement but has no rectal or abdominal pain.  He works as a truck driver, and his diet consists mainly of hamburgers and French fries.  Abdominal examination is unremarkable.  There is no mass or tenderness on digital rectal examination, but anoscopy shows bulging purplish-blue mucosal lesions above the dentate line.  Rubber band ligation of the lesions is most likely to involve which of the following?

A) Deep external pudendal artery branches
B) External iliac vein tributaries
C) Inferior mesenteric vein tributaries
D) Internal pudendal vein tributaries
E) Left colic artery branches
F) Superior vesical artery branches

Correct Answer:

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