A Case of an Acute Hemorrhagic Rectal Ulcer Treated with a Transanal Mucosal Circular Resection

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  • 止血に難渋した急性出血性直腸潰瘍に対し経肛門的直腸粘膜環状切除が有効であった1例

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Abstract

We herein report a case of intractable bleeding from an acute hemorrhagic rectal ulcer which was successfully treated with a transanal mucosal circular resection of the rectum. An 81-year-old male had been suffering from diabetes and chronic renal failure, and therefore had been regularly undergoing maintenance hemodialysis. He was hospitalized because of an acute myocardial infarction and he therefore underwent coronary artery bypass graft surgery. Massive lower gastrointestinal bleeding thereafter developed and colonoscopy revealed circumferential multiple round or irregular shaped ulcerations on the distal rectum. Treatment using the pressure method by tamponade and/or endoscopic clipping only allowed for temporary hemostasis. Recurrent massive bleeding from the lower rectum continued, and the amount reached a maximum volume of 2,000ml a day. As a result, per anal suturing of the bleeding ulcer in the operation room was performed. However, severe re-bleeding occurred shortly thereafter, and so an emergency operation consisting of a transanal mucosal circular resection, measuring approximately 2.5cm in width, was performed with anal sphincter conservation. In addition, a double-barrel sigmoid colostomy was constructed at the same time and the successful management of the acute hemorrhagic rectal ulcer was thus finally achieved.<br>

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