A case of acute hemorrhagic rectal ulcerrequiring stoma placement for refractory bleeding and persistent bacteremia

Abstract

Rectal ulcers can cause severe bleeding,with some cases being refractory. We report a case in which the addition of acolostomy resulted in a good outcome in terms of treatment of bleeding andinfection. The patient was a 70 year old male being treated for pneumonia andseptic shock caused by invasive Streptococcus pneumoniae. On the 21st day ofillness, he developed massive hemorrhage and was subsequently diagnosed with anacute hemorrhagic rectal ulcer and underwent endoscopic hemostasis. On day 28, bleeding resumed. At this time, endoscopichemostasis was difficult, and surgical hemostasis was performed. On day 38, thepatient developed bacteremia due to Pantoea septica. Bleeding resumed on days47 and 53, and endoscopic hemostasis was performed each time. A colostomy wasadded on day 56 to stop bleeding and avoid fecal contamination, and thepatient's general condition improved.