Clinical and endoscopic features of acute hemorrhagic rectal ulcer.
BACKGROUND
Acute hemorrhagic rectal ulcer (AHRU) has increasingly been reported in Japan, whereas it has rarely been reported in the English literature and is not yet established as a disease entity. The aim of this study was to elucidate clinical and endoscopic characteristics of patients with AHRU.


METHODS
We enrolled 20 patients with 26 ulcers diagnosed as AHRU in our department between January 2001 and October 2005. Clinical features such as the underlying disorder, Karnofsky performance status (PS), and presence or absence of anticoagulant or antiplatelet therapy, as well as endoscopic findings and type of bleeding, were evaluated. Strategies for hemostasis were also reviewed.


RESULTS
The most prevalent underlying disorder was diabetes mellitus, and the number of bedridden patients with PS 4 was relatively high. In addition, more than half of the patients had been treated with anticoagulant or antiplatelet agents. Endoscopically, ulcers were characteristically solitary and irregularly shaped, and they did not show any typical localization pattern. As a hemostatic strategy, clipping alone showed a favorable result, with a hemostatic success rate as high as 76.9%.


CONCLUSIONS
This study may support the establishment of AHRU as a new clinical entity. In aged patients being treated with anticoagulant or antiplatelet agents, especially bedridden patients using aspirin, the possible appearance of this disease should be kept in mind.
Oku
Takatomi
T
Department of Gastroenterology, Shinnittetsu Muroran General Hospital, 1-45 Chiribetsu, Muroran, Japan.
Maeda
Masahiro
M
Ihara
Hideyuki
H
Umeda
Ikumi
I
Kitaoka
Keisuke
K
Waga
Eriko
E
Wada
Yuko
Y
Katsuki
Shinichi
S
Nagamachi
Yasuhiro
Y
Niitsu
Yoshiro
Y
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D003937:Diagnosis, Differential; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies