Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complication...Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.展开更多
Colitis cystic profunda is a rare entity benign condition of the colon and rectum that can mimic suspicious polyps or malignancy. The commonest sites of affectation are the rectum and the sigmoid colon but it can be u...Colitis cystic profunda is a rare entity benign condition of the colon and rectum that can mimic suspicious polyps or malignancy. The commonest sites of affectation are the rectum and the sigmoid colon but it can be unusually widely distributed in the colon. The aetiology of this condition is not fully elucidated and confident diagnosis can only be made on histological features. We hereby describe a patient who presented with significant rectal symptoms and an unexpected finding of a submucosal mucous cyst mimicking a suspicious rectal polyp and highlighted its significance and the review of the literature.展开更多
Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of muc...Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.展开更多
目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进...目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进行回顾性分析并按照出血原因的不同进行归类整理。结果粪性溃疡26例,包括19例多发溃疡、7例单发溃疡,患者平均年龄为(68.3±14.6)岁,中位卧床时间为12.0(9.0,19.3)d,使用抗凝、抗血小板药物的有12例。急性出血性直肠溃疡综合征(AHRUS)15例,包括6例多发溃疡、9例单发溃疡,患者平均年龄为(65.7±11.5)岁,中位卧床时间为10(8,17)d,使用抗凝、抗血小板药物的有7例。粪性溃疡、AHRUS患者采用电子结肠镜下钛夹夹闭止血、经肛门缝合结扎止血或(电子结肠镜下电凝后)凡士林纱布填塞压迫止血等方式处理后,出血完全控制。异物损伤2例,考虑原因分别为开塞露操作不当、灌肠操作,经肛门缝合结扎止血后出血得以控制。直肠憩室1例,予以蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后出血得以控制。直肠癌1例,予蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后症状好转,后由于直肠癌基础疾病,患者家属放弃进一步治疗,患者死亡。结论临床中应对突发无痛性大量便血予以足够重视,早期发现并积极处理对患者的临床转归具有重要的意义。对于老年卧床患者、合并严重基础疾病的卧床患者,要注意考虑粪性溃疡、AHRUS的可能。展开更多
Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various les...Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.展开更多
文摘Endoscopic hemorrhoidal band ligation is a well-established nonoperative method for treatment of bleeding internal hemorrhoids(grade 1 to 3). It is a safe and effective technique with a high success rate. Complications with this procedure are uncommon. Although rectal ulceration due to band ligation is a rare complication, it can cause life-threatening hemorrhage especially when patients are on medications which impair hemostasis like aspirin or non steroidal antiinflammatory drugs. We present 2 cases of massive lower gastro-intestinal bleeding in patients who had a band ligation procedure performed 2 wk prior to the presentation and were on aspirin at home. Both the patients were hemodynamically unstable requiring resuscitation. They required platelet and blood transfusions and were found to have rectal ulcers on colonoscopy done subsequently. The rectal ulcers corresponded to the site of band ligation. The use of aspirin by these patients would have caused defects in the hemostasis and may have predisposed them to massive bleeding in the presence of rectal ulcers occurring after the band ligation procedure. Managing aspirin before and after the ligation may be difficult especially since adequate guidelines are unavailable. Stopping aspirin in all the cases might not be safe and the decision should be individualized.
文摘Colitis cystic profunda is a rare entity benign condition of the colon and rectum that can mimic suspicious polyps or malignancy. The commonest sites of affectation are the rectum and the sigmoid colon but it can be unusually widely distributed in the colon. The aetiology of this condition is not fully elucidated and confident diagnosis can only be made on histological features. We hereby describe a patient who presented with significant rectal symptoms and an unexpected finding of a submucosal mucous cyst mimicking a suspicious rectal polyp and highlighted its significance and the review of the literature.
文摘Solitary rectal ulcer syndrome (SRUS) is a rare condition in children. We report a case of SRUS in an 8-year old Saudi girl who presented with recurrent rectal bleeding,intermittent mucosal prolapse,and passage of mucus per rectum. Colonoscopy revealed multiple polypoid mass lesions with histopathological features of SRUS. The polypoid variant of SRUS is very rare in children and may be confused with rectal malignant or inflammatory conditions.
文摘目的总结突发无痛性大量便血的卧床患者的临床资料,以期为临床诊治提供参考。方法本研究纳入分析的患者便血出血量大于400 m L,卧床时间为7 d及以上。本院2010年1月至2020年12月诊治的符合研究纳入条件的患者共45例,收集其临床资料,进行回顾性分析并按照出血原因的不同进行归类整理。结果粪性溃疡26例,包括19例多发溃疡、7例单发溃疡,患者平均年龄为(68.3±14.6)岁,中位卧床时间为12.0(9.0,19.3)d,使用抗凝、抗血小板药物的有12例。急性出血性直肠溃疡综合征(AHRUS)15例,包括6例多发溃疡、9例单发溃疡,患者平均年龄为(65.7±11.5)岁,中位卧床时间为10(8,17)d,使用抗凝、抗血小板药物的有7例。粪性溃疡、AHRUS患者采用电子结肠镜下钛夹夹闭止血、经肛门缝合结扎止血或(电子结肠镜下电凝后)凡士林纱布填塞压迫止血等方式处理后,出血完全控制。异物损伤2例,考虑原因分别为开塞露操作不当、灌肠操作,经肛门缝合结扎止血后出血得以控制。直肠憩室1例,予以蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后出血得以控制。直肠癌1例,予蛇毒血凝酶灌肠、凡士林纱布填塞压迫止血后症状好转,后由于直肠癌基础疾病,患者家属放弃进一步治疗,患者死亡。结论临床中应对突发无痛性大量便血予以足够重视,早期发现并积极处理对患者的临床转归具有重要的意义。对于老年卧床患者、合并严重基础疾病的卧床患者,要注意考虑粪性溃疡、AHRUS的可能。
文摘Endoscopic clipping has been established as a safe and effective method for the treatment of nonvariceal upper gastrointestinal bleeding in numerous randomized studies.Recently,clipping has been applied to various lesions in the lower gastrointestinal tract,including diverticular bleeding,postpolypectomy bleeding,and repair of perforations with successful outcomes.We review the safety and efficacy of this maneuver for the management of diseases in the lower gastrointestinal tract.
