title: Massive hematochezia from acute hemorrhagic rectal ulcer in patients with severe comorbid illness: rapid control of bleeding by per anal suturing of bleeder using anoretractor.
abstract: OBJECTIVE
  Massive hematochezia from acute hemorrhagic rectal ulcer can arise in patients with severe comorbid illness who are bedridden for long periods. If the bleeder is not found and treated immediately, the bleeding will cause deterioration of health and even threaten life. The results of the current study show how quickly and safely per anal suturing can treat acute hemorrhagic rectal ulcer.
  
  
  METHODS
  From January 2003 to December 2003, the records of 26 patients who underwent per anal suturing of acute hemorrhagic rectal ulcer were retrospectively reviewed. The identification of acute hemorrhagic rectal ulcer was confirmed by clinical and anoscopic examination.
  
  
  RESULTS
  Most of these patients were elderly and bedridden (14 men; median age 69 years). Main comorbid illnesses existed in all patients and included liver cirrhosis (8 patients, 31 percent), sepsis (13 patients, 50 percent), cerebral vascular accident (15 patients, 58 percent), respiratory failure (13 patients, 50 percent), and malignancy (7 patients, 27 percent). Effective hemostasis was achieved in all patients by direct suture of bleeding ulcer. No complications developed relative to the per anal suturing procedure among any patients. Although 11 patients developed recurrent hematochezia, 9 patients responded to repeated therapy. The risk factors associated with recurrent bleeding were severity of disease and abnormal coagulation.
  
  
  CONCLUSIONS
  When massive hematochezia occurs in bedridden patients with severe comorbid illness, it is essential to investigate the lower rectum, which often is affected by acute hemorrhagic rectal ulcer. Recognition of this clinical presentation will result in early identification and therapy. Per anal suturing of a bleeder at the bedside provides a quick, safe, and successful management of acute hemorrhagic rectal ulcer.
authors.affiliation: Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. hsin3345@vip5168.com.tw
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Hung
authors.forename: Chung-Rong
authors.initials: CR
authors.lastname: Changchien
authors.forename: Jeng-Fu
authors.initials: JF
authors.lastname: You
authors.forename: Jinn-Shiun
authors.initials: JS
authors.lastname: Chen
authors.forename: Jy-Ming
authors.initials: JM
authors.lastname: Chiang
authors.forename: Chien Yuh
authors.initials: CY
authors.lastname: Yeh
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Fan
authors.forename: Reiping
authors.initials: R
authors.lastname: Tang
authors.forename: Pao-Shiu
authors.initials: PS
authors.lastname: Hsieh
authors.forename: Wen-Sy
authors.initials: WS
authors.lastname: Tasi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques; D014456:Ulcer / Q000150:complications / Q000601:surgery*