A Case study of acute hemorrhagic rectal ulcer -Clinical features and endoscopic hemostasis-

Abstract

We here report a case study of acute hemorrhagic rectal ulcer (AHRU) . From April 1 2007 to July 31 2010, 20 patients presenting with sudden-onset of hematochezia were diagnosed as AHRU. AHRU was diagnosed based on endoscopic findings. Data regarding demographics and colonoscopy were retrospectively retrieved. The patients consisted of seven males and thirteen females with a mean age of 78.3 year ranging from 58 to 96. The co-morbid diseases included hypertension, diabetes mellitus, chronic renal failure, cerebrovascular disease and terminal stage of cancer. Most of patients were bedridden because of disabilities due to the co-morbid diseases. Four patients were exposed to anti-coagulation agents. Colonoscopy which was performed within 24 hours of hematochezia revealed single ulcer in 6 patients and multiple rectal ulcers in 14 patients. In 13 cases, the ulcers were irregular in shape while Dieulafoy type ulcer was observed in 5 cases. Exposed blood vessels were detected in 11 patients (55%) to whom endoscopic hemostasis was challenged. In all but two cases, treatment was successful (82%) irrespective of procedures. The procedure employed were clipping in 5, argon plasma coagulation (APC) in 2, local injection of hypertonic saline-epinephrine solution together with APC in 1 and endoscopic band ligation in 1. Two patients failed endoscopic hemostasis and subsequently received surgery. One of the two patients died of multiple organ failure after surgery. The demographic features of AHRU in the current study were mostly consistent with those previously reported ; immobilized elderly patients with co-morbid diseases. In contrast to other reports, female were predominant. Endoscopic hemostasis was effective for active bleeding and may be a first-line therapy for AHRU.