title: Acute hemorrhagic rectal ulcer: an important cause of lower gastrointestinal bleeding in the critically ill patients.
abstract: OBJECTIVE
  The occurrence of acute hemorrhagic rectal ulcer (AHRU) in patients in the intensive care unit (ICU) has not been well investigated. The aims of this study were to evaluate the clinical manifestations and outcomes in these patients.
  
  
  METHODS
  The patients developing significant acute lower gastrointestinal (LGI) bleeding after ICU admission from July 2002 to December 2007 were retrospectively reviewed. Bedside colonoscopy was performed within 24 h of bleeding, and those patients with bleeding from AHRU were studied. Ulcers with stigmata of recent bleeding were treated with endoscopic hemostasis, and the outcome of these patients was analyzed.
  
  
  RESULTS
  AHRU occurred in 36 of 114 patients (31.6%) and was the most common cause of acute LGI bleeding after ICU admission. Most patients had comorbidities, such as respiratory failure, renal failure, diabetes mellitus, or atherosclerosis. Fourteen patients (38.9%) developed hypovolemic shock after the onset of bleeding. Endoscopic therapy was performed in 29 patients with 97.2% success rate for hemostasis. Fourteen patients (48.3%) developed rebleeding within 4 weeks. This was controlled by repeated endoscopic intervention. Anticoagulant use was the risk factor for rebleeding after treatment. The survival rate at 4 weeks after bleeding was 52.8%. Logistic regression analysis revealed thrombocytopenia (platelet count <150,000/mm(3)) and more than one comorbidity were independent predictors for mortality.
  
  
  CONCLUSIONS
  AHRU is an important etiology of acute LGI bleeding in the patients with critical illness. Bedside colonoscopy is helpful for early diagnosis and treatment. The underlying comorbidities of the patients influence the outcome after bleeding.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section 2, Banciao, 22060 New Taipei City, Taiwan.
authors.forename: Cheng-Kuan
authors.initials: CK
authors.lastname: Lin
authors.forename: Cheng-Chao
authors.initials: CC
authors.lastname: Liang
authors.forename: Hou-Tai
authors.initials: HT
authors.lastname: Chang
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Hung
authors.forename: Tzong-Hsi
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003113:Colonoscopy; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012002:Rectal Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014456:Ulcer / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology