caa a22 4500 445794763 CHVBK 20180317145121.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s10620-011-1759-y doi (NATIONALLICENCE)springer-10.1007/s10620-011-1759-y Acute Hemorrhagic Rectal Ulcer: An Important Cause of Lower Gastrointestinal Bleeding in the Critically Ill Patients [Elektronische Daten] [Cheng-Kuan Lin, Cheng-Chao Liang, Hou-Tai Chang, Fang-Ming Hung, Tzong-Hsi Lee] Background and Aim: The occurrence of acute hemorrhagic rectal ulcer (AHRU) in patients in the intensive care unit (ICU) has not been well investigated. The aims of this study were to evaluate the clinical manifestations and outcomes in these patients. Method: The patients developing significant acute lower gastrointestinal (LGI) bleeding after ICU admission from July 2002 to December 2007 were retrospectively reviewed. Bedside colonoscopy was performed within 24h of bleeding, and those patients with bleeding from AHRU were studied. Ulcers with stigmata of recent bleeding were treated with endoscopic hemostasis, and the outcome of these patients was analyzed. Results: AHRU occurred in 36 of 114 patients (31.6%) and was the most common cause of acute LGI bleeding after ICU admission. Most patients had comorbidities, such as respiratory failure, renal failure, diabetes mellitus, or atherosclerosis. Fourteen patients (38.9%) developed hypovolemic shock after the onset of bleeding. Endoscopic therapy was performed in 29 patients with 97.2% success rate for hemostasis. Fourteen patients (48.3%) developed rebleeding within 4weeks. This was controlled by repeated endoscopic intervention. Anticoagulant use was the risk factor for rebleeding after treatment. The survival rate at 4weeks after bleeding was 52.8%. Logistic regression analysis revealed thrombocytopenia (platelet count <150,000/mm3) and more than one comorbidity were independent predictors for mortality. Conclusions: AHRU is an important etiology of acute LGI bleeding in the patients with critical illness. Bedside colonoscopy is helpful for early diagnosis and treatment. The underlying comorbidities of the patients influence the outcome after bleeding. Springer Science+Business Media, LLC, 2011 Lower gastrointestinal bleeding nationallicence Acute hemorrhagic rectal ulcer nationallicence Colonoscopy nationallicence Intensive care unit nationallicence AHRU : Acute hemorrhagic rectal ulcer nationallicence ICU : Intensive care unit nationallicence LGI bleeding : Lower gastrointestinal bleeding nationallicence APACHE-II : Acute Physiology and Chronic Health Evaluation II nationallicence Lin Cheng-Kuan Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut Liang Cheng-Chao Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut Chang Hou-Tai Medical Intensive Care Unit, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan aut Hung Fang-Ming Surgical Intensive Care Unit, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan aut Lee Tzong-Hsi Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3631-3637 0163-2116 56:12<3631 2011 56 10620 https://doi.org/10.1007/s10620-011-1759-y text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1759-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lin Cheng-Kuan Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut NATIONALLICENCE 700 1- Liang Cheng-Chao Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut NATIONALLICENCE 700 1- Chang Hou-Tai Medical Intensive Care Unit, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan aut NATIONALLICENCE 700 1- Hung Fang-Ming Surgical Intensive Care Unit, Far Eastern Memorial Hospital, Banciao, New Taipei City, Taiwan aut NATIONALLICENCE 700 1- Lee Tzong-Hsi Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Section2, Banciao, 22060, New Taipei City, Taiwan aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/12(2011-12-01), 3631-3637 0163-2116 56:12<3631 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer