A 55 year old male recently discharged from the hospital after treatment for sepsis due to post-obstructive pneumonia related to lung cancer, and a DVT treated with Lovenox , developed hematochezia with passage of blood clots. Sigmoidoscopy at presentation revealed a large, nearly circumferential rectal ulcer, with islands of normal appearing intervening mucosa and no focal bleeding source seen. During his prior hospitalization he had a rectal tube placed after developing diarrhea and an ischemic ulcer was suspected.
The patient developed recurrent hematochezia with the passage of clots and hypotension the next day. A repeat sigmoidoscopy revealed a spurting vessel within the rectal ulcer. Given the deep ulcer base and the degree of bleeding seen, a clip was placed directly on the vessel with good hemostasis achieved. A small amount of oozing was seen superior to the clip site and a second clip was placed. The patient experienced no further rectal bleeding.
Harry Aslanian, M.D., Yale University
Catherine McCrann, MD, Yale University