Risk factors for recurrent bleeding from acute hemorrhagic rectal ulcer

Abstract

High CCI score was a predictor of recurrent bleeding from AHRU, but individual comorbidities, medications, endoscopic features or endoscopic hemostasis were not. Endoscopic hemostasis for bleeding from AHRU was achieved in most patients, but the recurrent bleeding rate was high.

Endoscopic and surgical management of acute haemorrhagic rectal ulcers

“…Acute massive rectal bleeding from ulcers affects comorbid patients unwell in ICU. [1][2][3] Significant haematochezia occurs in less than 1% of ICU patients and less than one-third is from acute haemorrhagic rectal ulcers (AHRU). 1 Although rare, AHRU remains important as the massive bleeding requires aggressive resuscitation and endoscopic or surgical intervention.…”

“…1 Although rare, AHRU remains important as the massive bleeding requires aggressive resuscitation and endoscopic or surgical intervention. [1][2][3] AHRU is described as large volume painless haematochezia characterized by rectal ulcers, not due to another condition. [1][2][3] Unlike solitary rectal ulcer syndrome, these ulcers are usually multiple and circumferential (44.4% in one review).…”

“…[1][2][3] AHRU is described as large volume painless haematochezia characterized by rectal ulcers, not due to another condition. [1][2][3] Unlike solitary rectal ulcer syndrome, these ulcers are usually multiple and circumferential (44.4% in one review). 1 Histological findings are necrosis, loss of epithelium and thrombosed vessels, similar to stress-induced ulcers in the upper gastrointestinal tract and may share a pathophysiology.…”

“…5 AHRU most commonly affects the elderly with comorbidities, most commonly hypertension, ischaemic vascular disease, diabetes and chronic kidney disease. 2,3 Up to 75% are on blood thinners and steroids are common. 3 Forty patients in one series were bedridden indicating an association with poor functional state.…”

“…3 Endoscopic methods are widely reported as initial treatment including clips, diathermy and adrenaline injections or a combination with an initial haemostasis rate up to 97.2%. [1][2][3] Transanal suturing is mostly used when endoscopic treatment fails. 1,3 While angiographic embolization is reported, some suggest it is associated with a higher rate of rebleeding and mortality; thus AHRU should be differentiated early from more common causes of rectal bleeding in ambulatory patients such as diverticular bleeding where angiography is often first-line.…”