Abstract
A 45-year-old housewife with a 10-year-history of systemic lupus erythematosus (SLE) was admitted on 2 December 1992, complaining of fever, mucocutaneous ulcerations, and anal pain. She was diagnosed as exacerbation of SLE because of clinical features and immunologic abnormalities. Though oral dosage of prednisolone (PSL) was increased, massive hematochezia developed on 15 December. Emergency colonoscopy revealed hemorrhage from the round-shaped discrete ulcer with normal surrounding mucosa, so-called “punched-out ulcer”, in the descending colon. We chose hemoclipping for hemos-tasis, but clipping procedure was difficult because of diffuse hemorrhage from the ulcer floor. Our methods were as follows ; (1) Hooking the one clip end at the anal margin of the ulcer. (2) Approaching the other end to the oral margin of the ulcer by pushing the forceps. (3) Planting the clip. After these procedures, the open ulcer was successfully closed. The 2nd colonoscopy on 25 December showed complete hemostasis and multiple various-shaped ulcers in the rectum and sigmoid colon which had not been observed due to residual blood on the 1st colonoscopy. Biopsy specimen taken from these ulcers suggested the etiology of ulcers was lupus vasculitis. The therapy with intravenous administration of PSL (100 mg daily) and hyperalimentaion induced remission of SLE and healing of cob-rectal ulcers.
