Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

Abstract

AHRU is an important etiology of acute LGI bleeding in the patients with critical illness. Bedside colonoscopy is helpful for early diagnosis and treatment. The underlying comorbidities of the patients influence the outcome after bleeding.

Acute hemorrhagic rectal ulcer syndrome: Comparison with non‐hemorrhagic rectal ulcer lower gastrointestinal bleeding

“…A recent study has shown that AHRU is the leading cause (31.6%) of acute lower GI bleeding in patients in ICU . AHRU can be life‐threatening and requires prompt investigation and management. Distinguishing distal colonic bleeding from proximal colonic bleeding is quite important because their bowel preparation needed to control bleeding under endoscopy is significantly different; a large amount of oral bowel cleansing solution is required in patients bleeding from the proximal colon, whereas that by using enema is sufficient to control bleeding from rectal ulcer.…”

Clinical course and rebleeding predictors of acute haemorrhagic rectal ulcer: 5‐year experience and review of the literature

“…With regard to predictors of AHRU rebleeding, we revealed that whole circumferential ulcer was a significant independent predictor of AHRU rebleeding. In previous reports, receiving anticoagulants , severity of comorbid disease and abnormal coagulation were reported to be predictors of rebleeding based on univariate analyses. In our study, atherosclerosis‐related comorbidities, use of antithrombotic drugs, use of corticosteroids and hypoalbuminaemia were not sufficient by themselves as rebleeding predictors, but it is reasonable to speculate that all of these features of AHRU patients contribute to highly frequent rebleeding of AHRU by delaying ulcer healing or facilitating the bleeding tendency.…”

“…With regard to the clinical course, we showed the typical time course of AHRU and revealed that the clinical course of AHRU was not necessarily good. The clinical course of AHRU has been described in a few reports, in which the median duration from hospitalization for underlying disease to onset of AHRU was 7.5 days [6], 11 days [5] and 21.5 days [3]; and the mean duration from initial endoscopic treatment to first rebleeding was 6.2 days [3] and 9 days [5]. These reports and our results reveal that AHRU tends to occur about 1-3 weeks after a patient becomes bedridden and that rebleeding tends to occur about 1 week after the initial bleeding.…”

Anorectal bleeding: etiology, evaluation, and management (with videos)

“…123,124 The term refers to solitary or multiple rectal ulcers associated with sudden, massive, painless rectal bleeding, usually in critically ill and/or bedridden elderly patients. The pathophysiologic basis of these ulcers is believed to be related to relative rectal mucosal ischemia secondary to supine positioning, atherosclerosis, and diabetes mellitus.…”

“…Hemostasis usually can be achieved with repeat endoscopic procedures; in refractory cases, angiographic embolization or per-anal suturing may be required. 123,124 Other causes of anorectal bleeding Less-frequent causes of anorectal bleeding include anal cancer (Fig. 12), rectal adenocarcinoma (Video 16), anal melanoma, inflammatory polyps ( Fig.…”