Clinical characteristics of acute hemorrhagic rectal ulcer

Background. Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with pain less, massive, fresh rectal bleeding in elderly, bedridden patients who hav e a serious primary disease. There have been several reports on AHRU in Jap an, but in Western countries, there have been none. We examined the clinica l characteristics of four cases, and we report on AHRU in Western countries . Study: The medical records and endoscopic findings in four patients with AHRU seen during a 3-year period were reviewed. The diagnosis of AHRU was e stablished by clinical symptoms, endoscopic examination, and other methods. Results. All of the patients were elderly and bed-ridden and all had sudde n onset of massive, fresh rectal bleeding without pain. Sigmoidoscopic exam ination of all patients showed a shallow or irregular bleeding ulcer in the lower rectum. In three cases, the clinical course was uneventful. In the o ther case, massive, fresh rectal bleeding recurred but transanal ligation w as effective. Conclusions: When painless, massive, fresh rectal bleeding oc curs in elderly and bed-ridden patients, it is important to carefully exami ne the lower rectum, as there is a strong possibility of AHRU.