CLINICAL AND ENDOSCOPIC FEATURES OF ACUTE HEMORRHAGIC RECTAL ULCER, PARTICULARLY IN REFRACTORY AND FATAL CASES
2022 Volume 64 Issue 4 Pages 983-991
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2022 Volume 64 Issue 4 Pages 983-991
Acute hemorrhagic rectal ulcer (AHRU), characterized by sudden painless and massive rectal bleeding in bedridden patients with severe comorbid illnesses, is increasingly being reported in Asia, particularly in Japan.
AIM: We investigated the clinical and endoscopic features of AHRU and the risk factors associated with a refractory and fatal course of this condition.
METHOD: We retrospectively reviewed the records of 44 patients with endoscopically documented AHRU between January 2016 and December 2017. We recorded the following data: (1) Patientsʼ background. (2) Endoscopic findings and hemostasis. (3) Rebleeding after primary hemostatic treatment. (4) Number of deaths.
RESULTS: (1) Most patients were elderly individuals (median age 78 years). We observed a relatively high number of bedridden patients with Eastern Cooperative Oncology Group performance status 3 or 4 (n=37, 84.1%). Comorbidities associated with AHRU included cardiovascular (n=10), cerebrovascular (n=9), and orthopedic diseases (n=7). (2) The ulcerative patterns of AHRU were endoscopically classified into the irregular (n=23), nearly circular (n=12), and Dieulafoy-like (n=9) lesions. Hemorrhage that necessitated hemostatic intervention occurred in >50% of patients (n=25, 56.8%); endoscopic placement of hemostatic clips was the most common method used (n=19). Most endoscopic primary hemostatic procedures were successful (96.0%). (3) Rebleeding occurred in 7 patients after endoscopic hemostasis. Steroid use was a risk factor for rebleeding after primary hemostasis (p=0.008). (4) Ten patients (22.7%) with AHRU died during hospitalization. Dialysis was identified as a risk factor for in-hospital mortality among patients with AHRU (p<0.001).
CONCLUSION: Endoscopic primary hemostasis was successful; however, some patients showed a refractory or fatal course. Notably, steroid use was a risk factor for rebleeding after hemostasis treatment, and dialysis was a risk factor for death in patients with AHRU and a complicated clinical course.
