An Acute Hemorrhagic Rectal Ulcer Caused by Alcohol Poisoning-induced Hypotension With Characteristics Similar to Those of Advanced Rectal Carcinoma

Abstract

A 72-year-old man was referred and admitted to our hospital because of anal bleeding. He had experienced transienthypotension (BP 60/40) as a result of acute alcohol poisoning one day before the symptom had appeared. A colonoscopyshowed an ulcerative lesion with mucosal necrosis and bleeding in the lower rectum. Computed tomography and abarium enema demonstrated a mucosal irregularity and a 6-cm stenotic segment in the lower rectum. A pathologicalstudy of the biopsied specimen showed no evidence of malignancy, ulcerative colitis, or Crohn's disease, although apositron emission tomography (PET) scan showed the strong accumulation of 2-fluoro-2-deoxy-D-glucose (FDG) inthe rectum. A subsequent colonoscopy showed morphological changes in the ulcer despite a lack of treatment, otherthan avoiding oral intake, and the inflamed mucosa improved gradually. During the 10-month period after the patient'shospital discharge, he experienced no symptoms, such as anal bleeding or abdominal pain, and the rectal ulcer healedwith no signs of stenosis. We concluded that the ischemic rectal ulcer had been caused by the transient shock state thatthe patient had experienced prior to the onset of rectal bleeding.