Lower Gastrointestinal Bleding from Acute Hemorhagic Rectal Ulcer in Criticaly Ill Patients

Abstract

Purpose: To elucidate the clinical characteristics and impacts of acute hemorrhagic rectal ulcer (AHRU) in critically ill patients during their stay in the ICUs of a university-affiliated hospital. Materials and Methods: From January 2005 to December 2006, medical records of ICU-hospitalized patients acquired a lower GI bleeding that required a colonoscopy done on an emergency basis were reviewed. Nineteen patients with acute hemorrhagic rectal ulcers were enrolled for evaluation. The baseline characteristics, clinical risk factors, and outcomes were analyzed. Results: There were 9 males and 10 females with a median age of 76.3 (range, 65-90) years. The majority of patients had significant life-threatening comorbid diseases. The average APACHE Ⅱ score was 19.2 (range, 8-28). Most of patients received mechanical ventilation (84.2%, 16/19), and more than half had ever used anticoagulant or antiplatelet agents (52.6%, 10/19). Overall in-hospital mortality was 47.3% (9/19). Hemorrhage-related death occurred in only one patient. Conclusions: In conclusion, this study indicated that acute hemorrhagic rectal ulcer was not an uncommon disease causing significant lower GI bleeding in critically ill patients. Patients with AHRU had poorer outcome and longer hospital stay. These life-threatening characteristics were largely attributable to underlying medical conditions but not LGI bleeding itself.