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

Abstract

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.

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

“…Although a worse ECOG performance status, a prolonged prior period of being bedridden and a history of constipation with a recent enema were also associated with AHRU diagnosis, we believe that serum ALB level is the most objective quantitative measure that can be readily assessed at initial presentation to evaluate the chronicity of the patient's underlying condition, which eventually leads to the development of AHRU. A lower performance status, multiple comorbidities and a decreased serum ALB level have also been reported to be significantly associated with an increased risk of massive transfusion in patients with AHRU . Multivariate‐adjusted analysis revealed that serum ALB level was a robust factor related to the diagnosis of AHRU.…”

“…We also suggested that serum ALB values may be important in distinguishing between AHRU and non‐AHRU, which may be useful in selecting the method of bowel preparation for colonoscopy. Previous studies of AHRU have primarily focused on the clinical and prognostic profiles or endoscopic features related to AHRU.…”

Risk Factors for Acute Hemorrhagic Rectal Ulcer Syndrome and Its Prognosis: A Density Case-Control Study

“…Previous observational studies have reported the characteristics of AHRUS patients, such as older age, immobility, antithrombotic drug use, and comorbidities such as diabetes mellitus, coronary artery diseases, cerebrovascular attacks, sepsis, liver failure [ 3 ], hypoalbuminemia [ 17 – 19 ], and chronic renal failure with hemodialysis [ 15 ]. The characteristics of cases in our research were compatible with those in observational studies and supported etiological assumptions except for older age [ 17 – 20 ]. Like others [ 6 , 7 ], we found that AHRUS patients often require hemostatic procedures and blood transfusion.…”

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

“…Furthermore, in our study, 12 patients (30%) developed whole circumferential ulcers. In previous reports, the forms of ulcers were variably described, such as nearly round type, irregular type, geographical type, circumferential type and Dieulafoy‐like type . These classifications of ulcer forms are ambiguous and one patient often has different types of ulcers concurrently.…”