TY - JOUR
T1 - Massive hematochezia from acute hemorrhagic rectal ulcer in patients with severe comorbid illness
T2 - Rapid control of bleeding by per anal suturing of bleeder using anoretractor
AU - Hung, Hsin Yuan
AU - Changchien, Chung Rong
AU - You, Jeng Fu
AU - Chen, Jinn Shiun
AU - Chiang, Jy Ming
AU - Yeh, Chien Yuh
AU - Fan, Chung Wei
AU - Tang, Reiping
AU - Hsieh, Pao Shiu
AU - Tasi, Wen Sy
PY - 2006/2
Y1 - 2006/2
N2 - PURPOSE: Massive hematochezia from acute hemorrhagic rectal ulcer can arise in patients with severe comorbid illness who are bedridden for long periods. If the bleeder is not found and treated immediately, the bleeding will cause deterioration of health and even threaten life. The results of the current study show how quickly and safely per anal suturing can treat acute hemorrhagic rectal ulcer. METHODS: From January 2003 to December 2003, the records of 26 patients who underwent per anal suturing of acute hemorrhagic rectal ulcer were retrospectively reviewed. The identification of acute hemorrhagic rectal ulcer was confirmed by clinical and anoscopic examination. RESULTS: Most of these patients were elderly and bedridden (14 men; median age 69 years). Main comorbid illnesses existed in all patients and included liver cirrhosis (8 patients, 31 percent), sepsis (13 patients, 50 percent), cerebral vascular accident (15 patients, 58 percent), respiratory failure (13 patients, 50 percent), and malignancy (7 patients, 27 percent). Effective hemostasis was achieved in all patients by direct suture of bleeding ulcer. No complications developed relative to the per anal suturing procedure among any patients. Although 11 patients developed recurrent hematochezia, 9 patients responded to repeated therapy. The risk factors associated with recurrent bleeding were severity of disease and abnormal coagulation. CONCLUSIONS: When massive hematochezia occurs in bedridden patients with severe comorbid illness, it is essential to investigate the lower rectum, which often is affected by acute hemorrhagic rectal ulcer. Recognition of this clinical presentation will result in early identification and therapy. Per anal suturing of a bleeder at the bedside provides a quick, safe, and successful management of acute hemorrhagic rectal ulcer.
AB - PURPOSE: Massive hematochezia from acute hemorrhagic rectal ulcer can arise in patients with severe comorbid illness who are bedridden for long periods. If the bleeder is not found and treated immediately, the bleeding will cause deterioration of health and even threaten life. The results of the current study show how quickly and safely per anal suturing can treat acute hemorrhagic rectal ulcer. METHODS: From January 2003 to December 2003, the records of 26 patients who underwent per anal suturing of acute hemorrhagic rectal ulcer were retrospectively reviewed. The identification of acute hemorrhagic rectal ulcer was confirmed by clinical and anoscopic examination. RESULTS: Most of these patients were elderly and bedridden (14 men; median age 69 years). Main comorbid illnesses existed in all patients and included liver cirrhosis (8 patients, 31 percent), sepsis (13 patients, 50 percent), cerebral vascular accident (15 patients, 58 percent), respiratory failure (13 patients, 50 percent), and malignancy (7 patients, 27 percent). Effective hemostasis was achieved in all patients by direct suture of bleeding ulcer. No complications developed relative to the per anal suturing procedure among any patients. Although 11 patients developed recurrent hematochezia, 9 patients responded to repeated therapy. The risk factors associated with recurrent bleeding were severity of disease and abnormal coagulation. CONCLUSIONS: When massive hematochezia occurs in bedridden patients with severe comorbid illness, it is essential to investigate the lower rectum, which often is affected by acute hemorrhagic rectal ulcer. Recognition of this clinical presentation will result in early identification and therapy. Per anal suturing of a bleeder at the bedside provides a quick, safe, and successful management of acute hemorrhagic rectal ulcer.
KW - Acute hemorrhagic rectal ulcer syndrome
KW - Critical illness
KW - Hematochezia
KW - Rectum
UR - http://www.scopus.com/inward/record.url?scp=32344437572&partnerID=8YFLogxK
U2 - 10.1007/s10350-005-0158-x
DO - 10.1007/s10350-005-0158-x
M3 - 文献综述
C2 - 16465586
AN - SCOPUS:32344437572
SN - 0012-3706
VL - 49
SP - 238
EP - 243
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 2
ER -