2026 Volume 68 Issue 7 Pages 1305-1310
An 80-year-old man was admitted to our hospital with sudden hematochezia. Contrast-enhanced CT revealed no bleeding source in the gastrointestinal tract. We suspected a hemorrhagic rectal ulcer and performed colonoscopy after preparatory treatment; however, the source of the bleeding remained unidentified. On day 8, recurrent hematochezia led to shock. A second colonoscopy revealed a pulsatile-exposed vessel in the rectum just above the anal dentate line. Hemostasis was achieved with local injection of HSE and clipping. Dieulafoy-type acute hemorrhagic rectal ulcer can cause hemorrhagic shock and are difficult to detect if the blood pressure is low or bleeding is stable. If a Dieulafoy-type acute hemorrhagic rectal ulcer is suspected, ensuring optimal visualization during endoscopy and selecting an appropriate hemostasis method are crucial.
