Clinical and endoscopic features of acute hemorrhagic rectal ulcer

Oku, Takatomi; Ihara, Hidetoshi; Umeda, Ikumi; Kitaoka, Keisuke; Waga, Eriko; Wada, Yuko; Katsuki, Shinichi; Nagamachi, Yukio; Niitsu, Yoshiro

doi:10.1007/s00535-006-1886-y

Cited by 22 publications

(51 citation statements)

References 17 publications

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“…This may be due to early resuscitation with aggressive component therapy, and endoscopic treatment while in the ICUs. In our study, the success rate of endoscopic hemostasis using a variety of modalities was similar to previous reports [4,5]. However, the rebleeding risk after endoscopic treatment was high (48.3%) in our patients, and was similar to that in a previous report (42%) [12].…”

Section: Discussionsupporting

confidence: 89%

“…Fujimaki et al [9] subsequently recognized it as a syndrome. AHRU is most commonly encountered in elderly, bed-ridden patients with serious comorbidities [4,5,8]. All of our patients were bed-ridden, and in need of mechanical ventilator support.…”

Section: Discussionmentioning

confidence: 99%

“…Reduced rectal mucosal blood flow in the supine position has been proposed as the pathogenesis of AHRU [10]. Atherosclerosis and diabetes mellitus have also been reported to have important associations with AHRU [5]. Thus, bed-ridden patients with multiple comorbidities in ICUs are particularly susceptible to this illness.…”

Section: Discussionmentioning

confidence: 99%

“…The endoscopic features of AHRU were classified as round, geographic shaped, circumferential, or Dieulafoy-like lesion ( Fig. 1) [4,5]. Patients with stigmata of recent bleeding (such as an active bleeding vessel, adherent clot, non-bleeding visible vessel, or diffuse oozing blood) were treated.…”

Section: Colonoscopy and Hemostasis Proceduresmentioning

confidence: 99%

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Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

et al. 2011

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Colonoscopy and Hemostasis Proceduresmentioning

confidence: 99%

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Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

et al. 2011

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“…The reported duration from hospitalisation to haematochezia ranged from 3 to 14 days (mean 7.5) 1. The endoscopic features are round, geographical, or circumferential ulcer located near the dentate line 1 , 3. Haemostasis can be achieved with endoscopic clipping, local injection of haemostatic agents, cauterisation, or transanal suture ligation 1 – 3…”

Section: Descriptionmentioning

confidence: 99%

Acute haemorrhagic rectal ulcer in fulminant hepatitis

Arakaki

Iraha²,

Shiroma³

et al. 2009

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Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

et al. 2022

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Objectives Acute hemorrhagic rectal ulcer syndrome (AHRUS) causes massive bleeding and often recurrent rebleeding from rectal ulcers that form immediately above the dentate line. This study aimed to determine the clinical background and risk factors contributing to rebleeding in patients with AHRUS and the most appropriate method of hemostasis treatment. Methods This retrospective study included 93 patients diagnosed with AHRUS at Showa University Fujigaoka Hospital, Japan, between April 2009 and November 2018. Information on clinical background factors, endoscopic findings, and hemostasis was obtained from medical records. The relationship with episodes of rebleeding was analyzed by multivariate logistic regression analysis. Results The median age was 79 years, and 84 patients (90%) had a performance status of grade 2 or higher. The patients had multiple background factors, with a median number of 5 per patient. The background factors could be classified into two major factors: those related to arteriosclerosis and those related to delayed wound healing. In the multivariate analysis, significantly more rebleeding occurred in patients with active bleeding during the initial endoscopy (odds ratio 4.88, 95% confidence interval 1.80–14.46, p = 0.003); significantly less rebleeding occurred in patients for whom hemostasis was first performed by clipping (odds ratio 0.30, 95% confidence interval 0.09–0.88, p = 0.035). Conclusions In bedridden older individuals with poor general health, multiple combinations of arteriosclerosis‐related factors and protracted wound healing factors can induce AHRUS. We strongly recommend performing hemostasis via the clipping method on suspected bleeding points, including active bleeding sites, in AHRUS.

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Clinical and endoscopic features of acute hemorrhagic rectal ulcer

Abstract: 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.

Cited by 22 publications

References 17 publications

Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients

Acute haemorrhagic rectal ulcer in fulminant hepatitis

Factors that affect the development of acute hemorrhagic rectal ulcer syndrome and rebleeding

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