Massive hematochezia from acute hemorrhagic rectal ulcer in patients with severe comorbid illness: Rapid control of bleeding by per anal suturing of bleeder using anoretractor

Hsin Yuan Hung*, Chung Rong Changchien, Jeng Fu You, Jinn Shiun Chen, Jy Ming Chiang, Chien Yuh Yeh, Chung Wei Fan, Reiping Tang, Pao Shiu Hsieh, Wen Sy Tasi

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)238-243
Number of pages6
JournalDiseases of the Colon and Rectum
Volume49
Issue number2
DOIs
StatePublished - 02 2006
Externally publishedYes

Keywords

  • Acute hemorrhagic rectal ulcer syndrome
  • Critical illness
  • Hematochezia
  • Rectum

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