Massive Rectal Bleeding Research Articles

Upper Gastrointestinal Bleeding in Patients with Chronic Renal Failure: What are the Particularities?

Introduction: Upper Gastrointestinal bleeding (UGIB) is a major cause of mortality in patients with renal failure. The aim of our study is to determine the epidemiological, lesional and prognostic profile of UGIB in chronic kidney disease (CKD) patients. Materials and Methods: This was a single-center study conducted from September 2017 to August 2023, including all patients with CKD admitted to the emergency department for upper GI bleeding who underwent Esogastroduodenoscopy (EGD). The various data were collected from endoscopy registries. Results: Of 662 patients admitted via the emergency department for UGIB, 59 cases of CKD (8.9%) were included, of which 43 cases were at the hemodialysis stage (72.88%). The mean age was 57.17 years, with a male predominance (sex ratio M/F 1.55). Isolated melena was the main reason for admission in 35 cases (59.32%), followed by hematemesis with melena in 9 cases (15.25%), and hematemesis without melena in 10 cases (16.94%), while massive rectal bleeding was present in 5 cases (8.47%). Esogastroduodenoscopy established the etiological diagnosis of UGIB in 40 cases (67.8%) and revealed the following lesions: 25 cases of peptic ulcer (62. 5%):2 cases (8%) of antral gastric ulcer,1 case (4%) of Forrest IIc bulbar ulcer, 12 cases (48%) of Forrest III bulbar ulcer and 10 cases (40%) of ulcerative bulbitis, 12 cases (30%) of gastric and duodenal angiodysplasia, 2 cases (5%) of Los Angelos grade B and C esophagitis and 1 case (2. 5%) of grade II of oesophageal varices ligatured in an unknown patient with portal hypertension. EGD was negative in 32.2% of cases. Conclusion: Upper GI bleeding is common in patients with chronic renal failure and is primarily caused by peptic ulcer disease and angiodysplasia.

Application of prostate resectoscope in the treatment of massive rectal bleeding after transrectal prostate puncture

BACKGROUND Ultrasound-guided prostate biopsy is a reliable diagnostic procedure for prostate cancer diagnosis with minimal procedure-related trauma. However, complications, such as massive rectal bleeding may occur after the puncture. We hypothesized that using a transrectal resectoscope could help treat massive rectal bleeding after transrectal prostate punctures. AIM To identify a simple and effective treatment for massive rectal bleeding after transrectal prostate punctures. METHODS Patients requiring treatment for massive rectal bleeding after transrectal prostate punctures were included. A SIMAI resectoscope was inserted through the anus. Direct electrocoagulation was performed for superficial bleeding points. Part of the rectal mucosa or surface muscle layer was removed to expose deep bleeding points, followed by electrocoagulation. An electric cutting ring was used to compress and stop the bleeding for jet-like points before electrocoagulation. The fluid color in the drainage tube was monitored postoperatively for continuous bleeding. RESULTS Eight patients were included from 2012 to 2022. None of the patients with massive rectal bleeding after the transrectal prostate punctures improved with conventional conservative and blood transfusion treatments. Two patients had an inferior artery embolism, and digital subtraction angiography was ineffective. All patients received emergency transanal prostate resection, which immediately stopped the bleeding. Four days after the procedure, the patients had recovered and were discharged. CONCLUSION Using a transanal prostate resection instrument is a simple, safe, and effective method for treating massive rectal bleeding after transrectal prostate punctures.

Management of Hemorrhoid Rubber Band Ligation Complications: Massive Rectal Bleeding

Management of Hemorrhoid Rubber Band Ligation Complications: Massive Rectal Bleeding

Hypovolemic Shock Due to Lower Gastrointestinal Tract Bleeding Secondary to Primary Rectal Syphilitic Ulcer. Case Report and Literature Review

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum, it has a well-defined course with several stages throughout its natural history ranging from primary to tertiary. Rectal syphilis is a rare syphilis presentation and can occur in both primary and secondary syphilis, either in a syphilitic ulcer or proctitis. It's generally doesn't have symptoms, however it can cause rectal bleeding that in most cases tends to be self-limiting. The diagnosis is established when it's possible with direct observation studies; However, in cases of concomitant contamination by spirochetes of the usual rectal flora, the sensibility and specificity of direct observation tests decreases, so the diagnosis requires an adequate clinical, serological and, if necessary, histopathological correlation. The treatment and follow-up is the same as in other syphilis types and depends on the time of evolution and specific conditions of the patient in question. We present the case of a male patient with primary rectal syphilis that during his course triggered a state of hypovolemic shock secondary to massive rectal bleeding.

Proctoscopy following transrectal prostate biopsy can control rectal bleeding after prostate biopsy.

Rectal bleeding is a common complication of transrectal ultrasound-guided prostate biopsy (TRPB). Massive rectal bleeding after TRPB can be life threatening. We initiated proctoscopy after TRPB to clarify the incidence of rectal bleeding and evaluated the usefulness of proctoscopy for controlling bleeding after TRPB. Two hundred and fifty six patients who underwent TRPB were included in the study. TRPB was performed under local anesthesia. Post-biopsy, we performed a proctoscopy to evaluate the degree of rectal bleeding at four levels (G0, no bleeding; G1, traces; G2, venous bleeding requiring hemostasis; and G3, massive venous bleeding or arterial bleeding). Once the bleeding site on the rectal wall was identified, a gauze tampon was placed at the bleeding site and compressed for a few minutes. A second proctoscopy was performed to confirm complete hemostasis, after which the TRPB was terminated. Proctoscopy revealed that the degree of bleeding was G0 in 27 cases, G1 in 104 cases, G2 in 116 cases, and G3 in nine cases. Rectal bleeding that required hemostasis (G2 and G3) was observed in 125 of 256 cases (48.3%). Among the 125 cases, bleeding was stopped by compression in 121 cases; in the remaining four cases, bleeding continued despite compression and was stopped by suturing of the bleeding site. Suturing was performed by urologists, and none of the 256 patients had problematic posterior hemorrhage. Proctoscopy enables precise and effective pressure hemostasis. Moreover, suturing hemostasis under direct vision can be performed in cases in which pressure hemostasis is difficult. Continued proctoscopy allays urologists' fear of post-TRPB rectal bleeding.

S3060 An Invading Stent: A Unique Case of Biliary Stent Impaction in the Cecum Causing Massive Rectal Bleeding

S3060 An Invading Stent: A Unique Case of Biliary Stent Impaction in the Cecum Causing Massive Rectal Bleeding

Off-label use of novel hemostatic gel to treat wound dehiscence after stapled hemorrhoidectomy.

A 54-year-old man complaining of massive rectal bleeding and severe anemia was referred to our endoscopic center by the surgical unit. He had undergone stapled hemorrhoidectomy with Longo’s technique 3 weeks before, and had received topical steroid and mesalamine therapy for 1 week without clinical improvement.

Massive rectal bleeding caused by diversion colitis

A 74-year-old male patient presented to the emergency department with hematochezia and dizziness. Seven years ago, the patient had a colonoscopy at another hospital, during which a perforation in the sigmoid colon was found; consequently, he underwent a loop colostomy. He was pale, with a blood pressure of 70/40 mmHg and a pulse of 130 beats per minute

S2883 Hemorrhagic Shock After TRUS-guided Prostate Biopsy Successfully Treated With Endoscopic Therapy

Introduction: Prostate cancer is the leading cause of malignancy and the 2nd overall cause of cancer-related deaths for men in the US today. Diagnosis involves transrectal ultrasound-guided prostate biopsy (TRUS-guided prostate biopsy), which has remained the gold standard. It provides a rapid diagnosis with a relatively low complication profile. Post biopsy, patients may commonly experience mild rectal bleeding, prostatitis, hematospermia or hematuria. However, one of the rarest complications of TRUS-guided prostate biopsy is massive rectal bleeding requiring angiographic or endoscopic therapy. In literature to date, only a few case reports exist describing this. We present a case of hemorrhagic shock after TRUS-guided prostate biopsy that was successfully treated with endoscopic hemoclipping and epinephrine injection. Case Description/Methods: A 64-year-old male presented with 6 episodes of small-volume hematochezia six days after he underwent a TRUS- guided prostate biopsy. Initially, he had normal vitals with a hemoglobin of 8.2 g/dL, compared to a baseline of 13.0 g/dL. On day two, he developed four large episodes of hematochezia, profound hypotension, and had an episode of syncope. The hemoglobin had dropped to 5 g/dL. CT angiogram showed no active bleeding. Massive transfusion protocol was initiated. Emergent flexible sigmoidoscopy showed a raised arterial-appearing lesion with active oozing in the rectum (Figure). Four hemoclips and 4cc of epinephrine were injected into the lesion, achieving hemostasis (Figure). Post endoscopy, the patient's hematochezia resolved and his hemoglobin stabilized. Patient suffered no further complications and was discharged home 48 hours after the endoscopy. Discussion: Mild rectal bleeding after TRUS-guided Prostate biopsy is common, the management is usually supportive care. Rectal gauze for tamponade can be used to control most cases of rectal bleeding. Uncommonly, these patients can progress to massive bleeding or hemorrhagic shock requiring radiologic or endoscopic therapy. Endoscopic options consist of local epinephrine, sclerosant injections, thermocoagulation, banding, or hemoclips. Recognizing the potential of severe bleeding after TRUS-guided prostate biopsy is integral in deeming who may benefit from early endoscopic therapy.Figure 1.: Active oozing from the biopsy site (top). Status post epinephrine and hemoclip placement (bottom).

S3435 Jejunal Diverticula: A Lesser Known Cause for Massive Lower GI Bleeding

Introduction: Small bowel diverticula are rare. We describe a case of Jejunal diverticula that caused massive lower GI bleeding requiring surgical intervention. Case Description/Methods: A 77 year old male presented to our ER with sudden onset bright red blood per rectum. The patient first noticed 2 days ago that his stool was dark red followed by red streaking on toilet paper. A few hours later he developed rectal urgency followed by another large bloody bowel movement along with associated diaphoresis, LLQ cramping and presyncope. Past medical history included GERD, BPH, Hypertension and Polycythemia Vera. He had never undergone an EGD and his last screening colonoscopy was normal 5 years ago. Labwork revealed acute anemia with Hb of 7.7 g/dL (baseline 13) and one unit of RBCs was therefore transfused. Emergent EGD and colonoscopy were performed and these were unremarkable apart from sigmoid diverticulosis. The following day massive rectal bleeding recurred and this time a radionuclide bleeding scan was obtained which was positive for active bleeding in small bowel lumen at the LUQ. Interventional Radiology did not feel the area was approachable for embolization. 6 additional units of RBCs were given due to persistent bleeding. General Surgery was called and the patient was taken to OR for exploratory laparotomy with small bowel resection. Diffuse proximal Jejunal diverticulosis was found to be actively bleeding with blood traveling all the way to distal colon. 60 cm of Jejunum was transected 30 cm from the ligament of Treitz. The patient had an unremarkable postoperative recovery with no further episodes of bleeding and stable Hemoglobin on serial CBCs. Discussion: Diverticulosis involving the small bowel, especially the Jejunum, is rare. These lesions have a higher incidence in the elderly and are acquired as a result of increased intraluminal pressure. They are thin and friable due to lack of muscularis layer. Concurrent colonic diverticulosis is common. Traditionally considered to be asymptomatic and incidental findings on imaging or surgical exploration, Jejunal diverticula can uncommonly cause lower GI bleeding. Traditional endoscopy is unhelpful given the lack of accessibility of the small bowel. CT Angiography and Nuclear Medicine bleeding scans may be beneficial to localize bleeding. Hemorrhage is usually brisk, requiring massive blood transfusion to maintain hemodynamics. Unstable patients should undergo emergent laparotomy so that resection of the involved segment can be performed.

Gastrointestinal stromal tumor revealed by hemorrhagic shock

Gastrointestinal Stromal Tumors (GISTs) are rare tumors of the digestive tract. The small intestine is the second most frequent localization of GIST after the stomach. We report a case of the ileal stromal tumor. The patient was admitted with a picture of hemorrhagic shock due to massive rectal bleeding. The fiberscope performed after stabilization was not objectified at the origin of the document while the CT scan objectified a mass of tissue density at the level of the right iliac fossa. Given the increasing evolution with the recurrence of patients to a target of a laparotomy for diagnostic and therapeutic purposes objectifying the tumor of the right iliac fossa at the expense of the ileum. The surgical procedure consisted of a major segmental resection of the tumor with ileo-ileal anastomosis. The anatomopathological study confirmed the diagnosis of the stromal tumor with good evolution. Through a general review of the literature, we have described the various clinical, para-clinical, anatomopathological, prognostic, and current therapeutic aspects specific to these tumors.

Gastrointestinal Stromal Tumor Revealed by Hemorrhagic Shock

Gastrointestinal stromal tumors (GISTs) are rare tumors of the digestive tract. The small intestine is the second most frequent localization of GIST after the stomach. We report a case of ileal stromal tumor. The patient was admitted with a picture of hemorrhagic shock due to massive rectal bleeding. The fibroscopy performed after stabilization was not objectified at the origin of the document while the CT scan objectified a mass of tissue density at the level of the right iliac fossa. Given the increasing evolution with the recurrence of patients to a target of a laparotomy for diagnostic and therapeutic purposes objectifying the tumor of the right iliac fossa at the expense of the ileum. The surgical procedure consisted of a major segmental resection of the tumor with ileo-ileal anastomosis. The anatomopathological study confirmed the diagnosis of stromal tumor with good evolution. Through a general review of the literature, we have described the various clinical, para-clinical, anatomopathological, prognostic and current therapeutic aspects specific to these tumors.

Massive gastrointestinal bleeding due to rectovaginal fistula: A rare case report

Rectovaginal fistula is usually observed due to obstetric traumas during giving birth, rectal or gynecologic malignities or after surgical therapy of malignant lesions or radiotherapy. Rectovaginal fistulas are not common in general surgery and gynecology clinics. However, these lesions are rarely seen during gastroenterology practice. In gastroenterology practice, we may face with rectovaginal fistula during Crohn’s disease’s course. These lesions deteriorate patients’ quality of life and increase morbidity and mortality. Endoscopy may be used to detect the localization of fistula and may help to choose correct treatment modality. Endoscopy sometimes may also be used to treat rectovaginal fistula via endoclips or stents. Typical complaints for rectovaginal fistulas are air, gas, or mucus discharge from vagina. Dyspareunia, perineal pain, or recurrent vaginal infections may also be seen. Rectal bleeding is not a common complaint for rectovaginal fistulas. Herein we report a rare case with rectovaginal fistula presenting with massive rectal bleeding after debulking surgery for ovarian carcinoma.

868 The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube

Abstract Introduction Acute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage. Presentation of case A 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding. Discussion The application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed. Conclusions Sengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

Laparoendoscopic Management of Colonic Trichobezoar Causing Acute Large Bowel Obstruction in an Adolescent Girl

Laparoendoscopic Management of Colonic Trichobezoar Causing Acute Large Bowel Obstruction in an Adolescent Girl

A 12-Years Rectal Bleeding Complicated with Deep Vein Thrombosis, Is Hemorrhoid the Real Cause?

Colorectal venous malformation is a rare condition that can cause massive rectal bleeding. This is the first report of colorectal venous malformation complicated with massive bleeding and lowers limb deep vein thrombosis, and the two life-threatening conditions were both treated successfully.

Acute hemorrhagic rectal ulcer: Experience in 11 patients at an urban acute care center in the USA

Introduction:Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA).Methods:A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU.Results:AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2–9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding.Conclusion:AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.

Successful treatment of a massive rectal bleeding from a Dieulafoy's lesion with endoscopic band ligation.

In relation to the article published in this journal by Pablo Menéndez-Sánchez et al. we have recently diagnosed a massive rectal bleeding from Dieulafoy's lesion. This was successfully treated with endoscopicbandligation.

A rare case of delayed massive rectal bleeding, after transrectal ultrasound- guided prostate biopsy, requiring a multidisciplinary approach treatment

Rectal bleeding seen after a transrectal ultrasound-guided prostate biopsy is often mild and self-limiting. We report a rare case of delayed massive rectal bleeding, post transrectal ultrasound-guided biopsy, in a man in active surveillance for prostate carcinoma, without risk factors for bleeding. We managed this complication with a successfully angiographic embolization.We present this case in detail and we analyze the possible causes of this complication.

Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report.

BACKGROUNDRectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage.CASE SUMMARYA 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up.CONCLUSIONRectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.