Differences between patients with inpatient-onset and outpatient-onset acute lower gastrointestinal bleeding: An observational study

Clinical and Economic Insights Into Surgery for Colonic Diverticular Perforation: A Long‐Term Observational Cohort Study

Aim

The clinical characteristics of colonic diverticular perforation are poorly understood. We aimed to clarify the clinical characteristics of colonic diverticular perforation.

Methods

Patients who underwent surgery for colonic diverticular perforation from 2011 to 2021 were retrospectively evaluated. The patients were divided into right‐ and left‐sided colon cohorts according to their perforation location.

Results

Of 1129 patients with gastrointestinal perforation, 138 had colonic diverticular perforation. The sigmoid colon was the most common perforation site. The patients were categorized into right‐sided (20 patients) and left‐sided (118 patients) colon cohorts. The number of patients with colonic diverticular perforation increased with age, as did the proportion of left‐sided perforations. The left‐sided cohort had significantly higher mean age, hemoglobin, and serum albumin levels than the right‐sided cohort. The blood urea nitrogen and serum creatinine levels were significantly lower in the right‐sided cohort. The proportion of patients with colostomy, the proportion of patients with postoperative complications, and the length of intensive care unit stay during hospitalization were significantly longer in the left‐sided cohort. The left‐sided cohort also had a considerably longer mean hospital stay and higher mean hospitalization costs than the right‐sided colon cohort. An age of ≥ 75 years tended to be associated with a prolonged hospital stay and high hospitalization costs in the left‐sided colon cohort.

Conclusions

The patients' conditions, length of hospital stay, and hospitalization costs were significantly worse in the left‐ than right‐sided colon cohort. The clinical characteristics differed according to the location of the diverticular perforation.

Rectal arterial embolization for hemostasis of acute hemorrhagic rectal ulcers: A case series

Acute hemorrhagic rectal ulcer (AHRU), though a relatively rare etiology of lower gastrointestinal bleeding, represents a critical clinical emergency characterized by sudden onset, painless, massive, and fresh rectal bleeding. While endoscopic hemostasis remains prominent therapy, its efficacy is limited in emergency settings by poor bowel preparation and obscured visualization. Rectal arterial embolization (RAE) offers a viable alternative, however, detailed descriptions of its application for AHRU in literature are lacking. Thus, we report a single-center experience of RAE in six patients with massive AHRU-related bleeding. Technical success was achieved in 83% (5/6) of cases, with clinical success was achieved in 100% cases (6/6). Rebleeding after initial RAE procedure occurred in 33% (2/6) of cases, one of which ultimately achieving hemostasis through transanal suturing after initial embolization failure. No major embolism-related complications were observed during follow-up. Moreover, complete embolization of rectal supplies demonstrated potential to reduce rebleeding risk, and empiric embolization may hold promise for managing refractory AHRU hemorrhage. These findings advocate for RAE as an effective alternative for AHRU hemorrhage, though further validation in larger cohorts is essential.

Acute Hemorrhagic Rectal Ulcer Presenting With Severe Lower Gastrointestinal Bleeding: A Case Report of an Emerging Entity

Acute hemorrhagic rectal ulcer (AHRU) is a rare but potentially life-threatening condition. We present the case of a 74-year-old man who developed sudden massive hematochezia and hypotension during hospitalization for fever of unknown origin. He was known to have alcohol-related liver cirrhosis, hypoalbuminemia and coronary artery disease (CAD) and was on daily aspirin. He was transfused and transferred to intensive care. Esophagogastroduodenoscopy (EGD) revealed no abnormalities, while colonoscopy showed two deep round ulcers in the distal rectum, one of which was spurting blood, promptly and successfully managed with hemoclip placement. There was no recent history of shock, constipation, or nonsteroidal anti-inflammatory drug (NSAID) use. A diagnosis of AHRU was made. The patient had no rebleeding but died two weeks later of septic shock. Gastroenterologists should consider AHRU in elderly patients with risk factors for AHRU such as prolonged bed rest, CAD, hypoalbuminemia, renal failure and anti-thrombotic drug use, who develop in-hospital lower gastrointestinal bleeding. Suggestive endoscopic findings are solitary or multiple rectal ulcer(s), with circumferential, round, Dieulafoy-like or geographical appearance and normal surrounding mucosa and location within 10 cm from the dentate line. Other etiologies should be excluded, and endoscopic hemostasis is often successful. It is important to recognize this entity and diagnose it early to decrease its associated morbidity and mortality.