Abstract
Background and Aim : Acute hemorrhagic rectal ulcer (AHRU) is the disease characterized by sudden onset of painless and massive rectal bleeding in elderly bedridden patients with severe comorbid illness. AHRU has increasingly been reported in Japan. The aim of this study is to elucidate the clinical characteristics in these patients.
Method : From April 2004 to June 2010, 28 patients were diagnosed with AHRU in our hospital. We investigated the clinical features, endoscopic findings, hemostatic treatment and course of patients with AHRU retrospectively.
Result : Most of these patients were elderly (median age 78.5) . The number of bedridden patients with Performance Status 3 and 4 is relatively high (82%) . Comorbid illness existed in all patients such as Diabetes mellitus (9 patients) , cardiovascular disease (9 patients) , chronic liver disease (8 patients) , cerebrovascular disease (7 patients) , chronic renal disease (7 patients) , orthopedic disease (7 patients) and malignancy (6 patients) . Endoscopic examination revealed irregularly shaped ulcer in 19 patients, round or nearly round small ulcer (s) in 7 patients, Dieulafoy-like ulcer in 2 patients. Exposed vessels were observed in 11 patients to whom endoscopic hemostatic treatment was performed. As a endoscopic treatment, Clipping was performed most frequently (9 patients) . Other treatments were endoscopic band ligation (2 patients) , local injection of hypertonic saline-epinephrine (HSE) solution with clipping (2 patients) . Successful hemostasis was achieved in 10 patients (91%) . 7 patients died by the aggravation of comorbid disease after bleeding related to AHRU.
Conclusions : However endoscopic hemostatic therapy is effective for active bleeding with AHRU, the underlying comorbidities of the patients influence the prognosis after bleeding.
