An Unusual Case of Lower Gastrointestinal Hemorrhage

Abstract

Question: A 53-year-old woman, who was in good health, presented with hematochezia for more than 20 days. Examination was unremarkable, with stable vital signs. Laboratory tests revealed a hemoglobin of 78 g/L (normal 120–160 g/L), and the rest of the laboratory tests were normal. Colonoscopy revealed multiple masses with a cobblestone appearance, obvious mucosal congestion, and edema in the junction of sigmoid and rectum (Figure A). Colonic biopsy precipitated active bleeding that required various measures to stop bleeding. Ice-cold saline solution and 8% norepinephrine (8 mg norepinephrine in 100 mL saline solution) was used to rinse the bleeding site repeatedly and to constrict the vessels, but failed to stop the bleeding. Titanium clip was then used to clamp the vessels, but blood still exudated. Lauromacrogol was injected to stop the bleeding eventually (Figure A). She recovered following fluid resuscitation, acid suppression and somatostatin therapy. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis is shown in Figure B–E. Three days later, she developed massive hematochezia with a hemoglobin level of 45 g/L. Owing to effective fluid resuscitation and blood transfusion, her blood pressure was relatively stable.