Clinical Characteristics and Short-Term Prognosis of Acute Hemorrhagic Rectal Ulcer: A Retrospective Study of 62 Patients

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  • 急性出血性直腸潰瘍62例の臨床像と急性期予後の検討

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This study evaluated the clinical features, endoscopic findings, treatment outcome and mortality rate within a short term (30 days) of 62 consecutive patients with acute hemorrhagic rectal ulcer (AHRU). The subjects consisted of 27 men and 35 women with a mean age of 81.6 years. They had comorbidities, such as dementia (69.4%), hypertension (51.6%), and orthopedic diseases (45.2%). Most of the patients showed Performance Status (PS) of 3-4 (64.5%). Forty-three patients (69.4%) developed AHRU after hospitalization for other diseases, while 19 patients (30.6%) were hospitalized with hematochezia. The main reason for hospitalization was orthopedic diseases, 16 (37.2%). Twenty-eight (45.2%) patients underwent hemostatic therapy with endoscopy, and 11 cases (17.7%) developed re-bleeding and 4 (6.5%) cases developed second re-bleeding. Median onset of re-bleeding and second re-bleeding were respectively 5 and 23 days after first colonoscopy, all onset within a short term. They were well managed with endoscopic hemostatic therapy except one who refused the therapy because of terminal condition. Among them, deaths within a short term totaled 4 (36.3%). Out of all 24 deaths, 14 (58.3%) occurred within a short term, all due to comorbidities or complications. AHRU is well managed with colonoscopy but high rates of re-bleeding, second re-bleeding and mortality were found within a short term after onset. Management of AHRU should focus on not only controlling the local bleeding but also managing the comorbidities and complications.

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