Sudden-onset, painless, and massive hematochezia in bedridden patients: a case series of 45 patients
[Objectives] To summarize the clinical data of 45 bedridden patients with sudden-onset, painless, and massive hematochezia and inform clinical treatment. [Methods] The analyses included 45 patients with hematochezia treated at our hospital between January 2010 and December 2020. All patients fulfill...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Journal of Colorectal & Anal Surgery
2022-04-01
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| Series: | 结直肠肛门外科 |
| Subjects: | |
| Online Access: | https://jcas.gxmuyfy.cn/cn/wqll/paper.html?id=439&cateName=2022%E5%B9%B4%20%E7%AC%AC28%E5%8D%B7%20%E7%AC%AC2%E6%9C%9F |
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| Summary: | [Objectives] To summarize the clinical data of 45 bedridden patients with sudden-onset, painless, and massive hematochezia and inform clinical treatment. [Methods] The analyses included 45 patients with hematochezia treated at our hospital between January 2010 and December 2020. All patients fulfilled the criteria of blood loss >400 mL and being bedridden≥7 days. Patients’clinical data were collected, analyzed, and categorized by the causes of hematochezia. [Results] Twenty-six patients were diagnosed with stercoral ulcer, including 19 patients with multiple ulcer and 7 with solitary ulcer; the mean(SD) age of these patients was 68.3(14.6) years with a median interval of being bedridden for 12.0(9.0, 19.3) days; 12 patients received anticoagulant and/or antiplatelet therapies. Fifteen patients had acute hemorrhagic rectal ulcer syndrome (AHRUS), including 6 with multiple ulcer and 9 with solitary ulcer; the mean(SD) age of these patients was 65.7(11.5) years, and the median interval of being bedridden for 10(8, 17) days; 7 patients received anticoagulant and/or antiplatelet therapies. The patients with stercoral ulcer or AHRUS were treated with titanium clamp under colonoscopy, transanal suture ligation, or Vaseline gauze compression (electrocoagulation under colonoscopy could be performed first); the bleeding was subsequently controlled. Two patients had foreign object damage, for which plausible causes included improper use of glycerine and enema; the bleeding was controlled after suture. One patient had rectal diverticulum; the bleeding was controlled after coloclysis with hemocoagulase and Vaseline gauze compression. One patient had rectal cancer, and bleeding was alleviated after coloclysis with hemocoagulase and Vaseline gauze compression; however, this patient died because the family refused further treatments. [Conclusion] Attention should be paid to patients with sudden-onset, painless, and massive hematochezia. Early identification and active treatment could significantly influence patients’prognoses. Stercoral ulcer and AHRUS should be considered for bedridden patients of older age or coexisting severe comorbidities. |
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| ISSN: | 1674-0491 |