II. Two Cases of Acute Massive Bleeding from the Rectal Ulcer due to Brain Diseases

Kohno, H.; Katsumi, Masaharu; Ura, Shogo; Shohji, Munehiro; Ieda, Katsuyuki; Ishimoto, Koichi; Ichimiya, Genta; Ryoh, K.; Tsuhada, Kenji

doi:10.3862/jcoloproctology.33.222

Cited by 6 publications

(2 citation statements)

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“…It was first reported by Kono et al in 1980. 1 Hirooka established the clinical entity of AHRUS based on his experience gained from treating 10 patients in 1984. 2 This disease is characterized by the sudden onset of painless but extensive bleeding from rectal ulcers located at the distal rectum, directly above the dentate line, in patients suffering from severe comorbidities.…”

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confidence: 99%

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Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

et al. 2022

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Objectives Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment. Methods This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis. Results The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing. In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80–14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09–0.88, p = 0.035). Conclusions In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis‐related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.

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Section: Introductionmentioning

confidence: 99%

“…It was first reported by Kono et al. in 1980 1 . Hirooka established the clinical entity of AHRUS based on his experience gained from treating 10 patients in 1984 2 .…”

Section: Introductionmentioning

confidence: 99%

Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

et al. 2022

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

Matsumoto

Inokuma

2013

Colorectal Disease

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Risk Factors and Management for Massive Bleeding of an Acute Hemorrhagic Rectal Ulcer

Hotta

Takifuji

Tonoda

et al. 2009

The American Surgeon™

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An acute hemorrhagic rectal ulcer (AHRU) is considered to be a potentially life-threatening illness requiring urgent identification and management because of massive bleeding. It is therefore important to clarify the factors associated with the massive bleeding of an AHRU and the best management. The factors associated with the massive bleeding of 14 patients with AHRU were determined by comparing the clinicopathologic features, laboratory data, and treatment between four patients with more transfusions (≥12 U) and 10 patients with less transfusions (≤3 U). Patients with AHRU of the more transfusion group had lower performance status (PS), more diabetes mellitus, more comorbid diseases, and lower serum albumin concentrate than those of the less transfusion group. More surgical treatment and the administration of hemostatic agents were necessary for the patients with AHRU of the more transfusion group than for those of the less transfusion group, and the duration from bleeding to hemostasis in patients with AHRU of the more transfusion group was larger than that of the less transfusion group. Patients with AHRU of the more transfusion group had a longer duration of no oral food intake, total parenteral nutrition, and hospital stay from bleeding day than those of the less transfusion group. Thus, the factors associated with the massive bleeding of AHRU were identified.

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II. Two Cases of Acute Massive Bleeding from the Rectal Ulcer due to Brain Diseases

Cited by 6 publications

References 1 publication

Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

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

Risk Factors and Management for Massive Bleeding of an Acute Hemorrhagic Rectal Ulcer

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