1996 Volume 29 Issue 7 Pages 1159-1163
A 62-year-old male on maintenance hemodialysis showed melena during conservative treatment for ileus. He was referred to our hospital, after which massive melena occurred intermittently. An exposed, pulsating vessel was noted on the rectal mucosa by endoscopy and bleeding occurred from this vessel during endoscopic examination. Hemostasis was achieved by endoscopically clipping this vessel, which led to improvement of the patient's general condition. However, multiple small nodular lesions were noted on the rectal mucosa on follow-up endoscopic examination. Examination of the biopsy specimens of these sites revealed granulation polyps that suggested mucosal regeneration. New hemorrhagic lesions were thereafter detected on the rectal mucosa. Clippings were performed again and the patient was then treated primarily for constipation. On subsequent endoscopic examination, the rectal mucosa had nearly normalized.
Acute hemorrhagic rectal ulcer is usually associated with serious illness, and is thought occur under conditions of stress. In the present case, bleeding initially occurred from an exposed vessel on the rectal mucosa under the serious condition of ileus. However, when his general condition subsequently improved, new mucosal bleeding developed, and this lesion was easily managed with treatment for constipation.
