Images in Surgery| Volume 155, ISSUE 5, P956-957, May 2014

Massive bleeding from visible vessels within a solitary rectal ulcer

Published:March 18, 2013DOI:
      A 77-year-old woman complained of numerous loose, maroon-colored stools. Laboratory findings revealed hemoglobin of 6.8 g/dL and a hematocrit of 14.6%. Colonoscopy showed 2 small rectal polyps, internal hemorrhoids, and a 6.0-cm giant superficial ulceration with protuberant large vessels on the right anterolateral wall of the rectum 1 cm above the pectinate line, with well-delimited borders. A large, pulsatile visible vessel that was not actively bleeding was observed within the ulcer bed (Figure). The visible vessels were injected with 5 mL of a solution of hypertonic saline with 1/10,000 epinephrine. The patient continued to bleed, requiring the transfusion of 8 units of packed blood cells, the wide suture ligation of multiple sites of hemorrhage was performed. Four days later, unexpected massive bleeding reoccurred, and a second wide suture ligation of the vessel in the base of the ulcer was performed. The patient survived 10 days after this last procedure. Pathologic findings of biopsies, along with the clinical history, confirmed a diagnosis of a solitary rectal ulcer syndrome (SRUS).
      Figure thumbnail gr1
      FigureRetroflexed sigmoidoscopic view of a giant circumferential solitary ulcer with irregular borders (white arrows), polypoid lesions, and a 3-mm visible vessel (yellow arrow) in the rectum.
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