title: Hemorrhagic rectal ulcer caused by a deformity of the coccyx complicated by normal delivery.
abstract: A 25-year-old woman delivered her first-born child weighing 3400 g by full-term normal delivery. Bloody stool developed 3 days after delivery. Colonoscopic examination revealed two linear ulcers parallel to the anal column on the posterior side of the rectal ampulla about 5 cm from the anal ring. Coagulated blood was detected at the ulcer bottom, suggesting the site of hemorrhage. Bowel rest in the absence of oral intake resulted in the disappearance of bloody stool. Three days later colonoscopic examination revealed improvement in the ulcer. There was no sign of constipation. A lateral pelvic radiograph showed that the apex of the coccyx was flexed anteriorly. The parturient canal may have physically pressed the rectum against the apex of the coccyx during delivery, causing mucosal injury. Only a few studies have reported the complication of a rectal ulcer due to injury during delivery. Furthermore, none of the previous studies has reported a rectal ulcer caused by deformity of the coccyx.
authors.affiliation: Department of Internal Medicine, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano 380-8582, Japan.
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Kaneki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Koyama
authors.forename: Shuichi
authors.initials: S
authors.lastname: Wada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Mori
authors.forename: Akira
authors.initials: A
authors.lastname: Kuraishi
authors.forename: Toru
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Akira
authors.initials: A
authors.lastname: Kawashima
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
mesh_terms: D003050:Coccyx / Q000002:abnormalities*; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D012002:Rectal Diseases / Q000209:etiology* / Q000628:therapy; D014456:Ulcer / Q000209:etiology* / Q000628:therapy