Massive Lower Gastrointestinal Hemorrhage Secondary to Rectal Hemorrhoids in Elderly Patients Receiving Anticoagulant Therapy: Case Series

Excerpt

Hemorrhages secondary to hemorrhoids are common but they are usually occult or oozing type with low amounts. Acute massive rectal hemorrhage is usually originated from upper GI (UGI) bleeding [1]. However, lower GI bleeding (LGI) may occasionally cause massive bleeding. In elderly patients, generally the reasons of colonic hemorrhage are diverticulum (17–40%), arteriovenous malformations (2–30%), colitis (9–21%), colonic neoplasms (11–14%), post-polypectomy, and anorectal pathologies (4–10%) [2]. Colonoscopy is the most important diagnostic tool for determining the focus of bleeding [3]. Generally massive LGI hemorrhage secondary to hemorrhoids has been reported in the literature as case presentations after surgical hemorrhoidectomy and rubber band ligation. Massive hemorrhoidal bleeding without any intervention has not been reported [4]. …