Clinical studies on acute hemorrhagic rectal ulcers

Fifty patients with acute hemorrhagic rectal ulcer (AHRU) seen at our hospital in the past 10 years, are reviewed to compare the clinical features and endoscopic findings with those reported previously. The subjects consisted of 20 men and 30 women with average age of 76.3, which means a higher incidence in women as well. The primary diseases on admission are mostly cerebrovascular diseases occurring in 18 patients. Fourteen patients presented with only melena or dehydration and 7 patients with fracture of femoral neck, who showed good general conditions. This clearly indicates that AHRU should develop even in patients without serious complications. The associated disorders included hypertension in 28 patients and diabetic mellitus in 11 patients. Forty-seven of 48 patients who were evaluated with detailed information had been confined to be in a bed-ridden condition at the onset of AHRU. This suggests that arteriosclerotic factors and physical factor such as bed-ridden condition may be a closely relatied to the development of AHRU. AHRU is generally characterized by indolent massive hematochezia. In this study, however, 2 patients presented with anal pain only and 9 patients with very slight bleeding. Endscopic examinations revealed that ulcers should be likely to be multiple and be localized in the lower rectum on the dentate line. Twenty-nine of 47 patients with detailed information had whole circumferential ulcer, which may be a characteristic finding of AHRU. In addition, this study suggests that treatment in the lateral position should be useful and effective for this disease.