### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 57 year old female who had a total proctocolectomy done Aug 30/11. I also am a liver transplant recipient (Sept 2005). I had Crohn s Disease for 12 years or so. The pathology report after my procotocolectomy showed signs of cancer in the part of the bowel that they removed. The doctors recommended I have chemotherapy (12 treatments) which I just finished in mid-June this year. I have been having problems lately with bleeding around the stoma which can be quite excessive (can fill up my ostomy bag quickly)., The blood is very red & I noticed tonight that there are blood clots in my bag. I emptied it a couple of times & the clots were in the bag both times within a one hour time frame. I managed to retrieve one of the clots from the bowl to have a good look at it & it looks like a red gel mould approximately 2 to 3 inches long & 2 inches wide! I am freaking out trying to figure out where it s coming from. I don t believe it s coming from the stoma itself. I think the bleeding is from around the stoma but can t figure out how the blood clots can come from outside the stoma! Help - I m totally freaking out!

### output:

It is not of much concern presently whether the bleeding is from within or around the stoma. What should concern us more is the cause of the bleeding. There could be a number of reasons, like late onset liver failure after transplant (leading to bleeding abnormality), chemotherapy induced bone marrow suppression (which decreases the number of platelets in the blood causing bleeding), recurrence of cancer in the remaining bowel, recurrence of Crohn's disease in the remaining bowel. Ruling them out one by one, I suggest you get a liver function test and complete blood count done. If these are normal, then you should undergo a contrast enhance computerized tomography (CT Scan) of the abdomen followed by an endoscopy from the stoma. These tests should clinch the diagnosis and the treatment accordingly can be instituted. Meanwhile, it is not a bad idea to show yourself to a surgeon just to rule out a local cause for the bleeding like skin infection/excoriation, etc.