Hemorrhaging is also known as bleeding or abnormal bleeding as a
result of blood loss due to internal.external leaking from blood
vessels or through the skin.
Hematochezia (rectal bleeding)
Hematochezia is defined as a condition of the passage of bright red,
bloody stool. In most cases it is an indication of hemorrhoids (swollen
veins in and around the rectum) or diverticulitis, a common digestive disease particularly found in the large intestine, as a result of infection or inflammation.
Causes
2.1. Ectopic pregnancy
There is a report of case of severe rectal bleeding due to an ectopic pregnancy in the wall of the cecum is reported. The usual preoperative studies for rectal bleeding
were performed but did not yield a definitive diagnosis. At laparotomy
the right side of the uterus was found to be adherent to the cecum(1).
2.2. Abdominal colic and major gastrointestinal haemorrhage
There is a report of a case of massive rectal bleeding resulting from the placental attachment of an abdominal
pregnancy to the sigmoid colon is reported. Both mother and infant
survived this rare complication which should be considered when abdominal colic
and major gastrointestinal haemorrhage occur in a pregnant patient(2).
Other researchers also report of a case of an unusual case of massive bleeding per rectum caused by erosion into the caecum of placental tissue from an ectopic pregnancy is presented. Despite its rarity, abdominal pregnancies may have to be considered in sexually active fertile women presenting with difficult torrential bleeding from the lower gastrointestinal tract(3).
2.3. Angiodysplastic lesions (vascular lesions of the gastrointestinal tract)
In the study of a single angiodysplasias demonstrated by preoperative
angiography in four patients and the review of the literature on
intestinal angiodysplastic lesions, found that the relative frequency of angiodysplasias in the right side of the colon
is noted. Visceral angiography is an important investigation in cases
where there is persistent or recurrent bleeding from the gastrointestinal tract, especially when barium studies and laparatomy have been negative(4).
2.4. Coagulation disorder
In the study of Rectal bleeding,
deep venous thrombosis, and coagulopathy in a patient with
Klippel-Trénaunay syndrome, reserachers indicated that this report
validates the use of endorectal resection for venous
malformation of the rectum in patients with KTS and highlights the
difficult balance of controlling bleeding by correction of a consumptive coagulopathy and the increased risk of thromboembolic complications(5).
2.5. Hemostatic disorders
In the report of a 79-year-old woman (weight, 69 kg) was hospitalized in a gastroenterology unit for severe rectal bleeding.
She had been treated for 2 months with dabigatran etexilate 110 mg
twice daily for chronic atrial fibrillation. On admission, her
creatinine clearance (CrCl) was 20.7 mL/min/1.73 m(2), prothrombin time
(PT) less than 10% (reference range 70-130%), and international
normalized ratio (INR) 14.5 (venous blood). Eleven days after admission, hematologic and renal function were normalized and rectal bleeding stopped. An 84-year-old man (weight, 71 kg) was admitted for rectal bleeding
with acute renal failure and dehydration that began while he was
treated with dabigatran etexilate 110 mg twice daily for atrial
fibrillation. On admission, CrCl was 33.5 mL/min/1.73 m(2), PT 13%, and
INR 7.53 (venous blood).
Dabigatran etexilate was stopped on admission. At the end of the
hospitalization, CrCl was 66.5 mL/min/1.73 m(2), PT 54%, and INR 1.53.
In both cases, an objective causality assessment revealed that those
adverse reactions were probably related to dabigatran etexilate(6).
2.6. Colon cancer
It can be with or without pain. In the study of 604 patients and 22
(3.6%, 95% confidence interval [CI] = 2.0% to 5.2%) were diagnosed with
colorectal cancer. Significant predictors of colorectal cancer
were found to be age (<50 years: odds ratio [OR] = 1; 50-69 years:
OR = 5.1, 95% CI = 1.4 to 18.6; > or = 70 years: OR = 8.2, 95% CI =
2.1 to 31.8) and blood mixed with the stool (Likelihood ratio [LR] 1.5;
adjusted OR = 3.8; 95% CI = 1.4 to 10.5). Presence of haemorrhoids
associated with bright red bleeding not mixed with stool reduced the likelihood of cancer (OR = 0.4, 95% CI = 0.1 to 1.2) but did not eliminate it--a cancer was present in 2% of patients with these symptoms(7).
2.7. Colorectal polyps
In the conduction of two studies, the first in 1989, the second in 1991, in which we invited
Danish general practitioners to register 3-4 patients aged 40 and over
presenting with rectal bleeding, researchers found that study 1 among 208 patients aged 40 and over and presenting with a first episode of rectal bleeding, colorectal cancer and polyps were present in 15.4 and 7.7%, respectively. In Study 2 among 209 patients aged 40 and over and presenting with overt rectal bleeding, 156 reported a first bleeding episode or a change in their usual bleeding pattern, and in this group colorectal cancer and polyps were diagnosed in 14.1 and 11.5%, respectively. In the group with unchanged bleeding
the cancer polyp prevalence was 6.7% (P < 0.05). The patients in
both studies were followed through a yearly letter to the GP for at
least 32 and 22 months, respectively(8).
2.8. Hemorrhoids
There is a report of within a period of 18 months, 387 patients were referred to the
Proctologic Service at the Chaim Sheba Medical Center because of
recurrent rectal bleeding. Hemorrhoids
were found in 194 of these patients and further investigation showed
that 45 of the 194 patients (23.2%) had other coexisting colonic
pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1
angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30
patients with hemoglobin less than 11 g/dl had additional colonic
pathology(9).
2.9. Etc.
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Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/309659
(2) http://www.ncbi.nlm.nih.gov/pubmed/3875846
(3) http://www.ncbi.nlm.nih.gov/pubmed/1295424
(4) http://www.ncbi.nlm.nih.gov/pubmed/4544790
(5) http://www.ncbi.nlm.nih.gov/pubmed/22424361
(6) http://www.ncbi.nlm.nih.gov/pubmed/22669799
(7) http://www.ncbi.nlm.nih.gov/pubmed/17007706
(8) http://www.ncbi.nlm.nih.gov/pubmed/8732328
(9) http://www.ncbi.nlm.nih.gov/pubmed/3872288
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