title: Massive rectal bleeding following transrectal ultrasound-guided prostate biopsy.
abstract: OBJECTIVE
  Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy, but is usually mild and stops spontaneously. We report five cases of life-threatening hemorrhage following this procedure, which were treated successfully by endoscopic injection.
  
  
  METHODS
  A total of 550 consecutive patients underwent TRUS-guided prostate biopsy in an outpatient setting. TRUS was performed using a Sonolayer 140 A (Toshiba) unit with a 7-MHz biplane transrectal probe, which was covered with two prophylactic sheaths. Sextant prostatic biopsies were systematically performed with a 16-gauge or 18-gauge needle without antibiotic prophylaxis.
  
  
  RESULTS
  Five patients (1%) presented rectal bleeding with hypovolemic symptoms shortly after the procedure. Emergency colonoscopy revealed active bleeding from biopsy sites in the anterior rectal wall. Endoscopic injection of epinephrine and polidocanol achieved control of bleeding and permanent hemostasis in all cases. The patients required hospitalization and a mean of 4 packed red blood cell units (range 2-7). The patients were discharged, with uneventful recoveries.
  
  
  CONCLUSIONS
  Colonoscopy should be carried out in patients presenting severe rectal bleeding after TRUS-guided prostate biopsy. Endoscopic treatment can be used to deal with this rare complication.
authors.affiliation: Corporació Sanitària Parc Taulí, Sabadell, Spain. ebrullet@cspt.es
authors.forename: E
authors.initials: E
authors.lastname: Brullet
authors.forename: M C
authors.initials: MC
authors.lastname: Guevara
authors.forename: R
authors.initials: R
authors.lastname: Campo
authors.forename: J
authors.initials: J
authors.lastname: Falcó
authors.forename: J
authors.initials: J
authors.lastname: Puig
authors.forename: A
authors.initials: A
authors.lastname: Prera
authors.forename: J
authors.initials: J
authors.lastname: Prats
authors.forename: J
authors.initials: J
authors.lastname: Del Rosario
mesh_terms: D000368:Aged; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D012007:Rectum; D014463:Ultrasonography