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Massive Hemorrhage from Rectal Ulcers in Chronic Renal Failure

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Eastern Virginia Medical School, Norfolk, Virginia

Ann Intern Med. 1984;100(3):397. doi:10.7326/0003-4819-100-3-397
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Massive lower gastrointestinal hemorrhage from rectal ulcers is unusual and frequently presents a difficult diagnostic challenge. Acute renal hemorrhage is usually associated with either arteriovenous malformation or diverticulosis, but is seen more rarely after rectal trauma, stercol ulceration, ulcerative colitis, and Crohn's disease (1, 2). Simple diagnostic maneuvers, such as sigmoidoscopy, to localize the point of bleeding are extremely important but frequently difficult because of the massive amount of blood in the rectum. Great care must be taken to clear all the blood and clots from the rectum so that all the rectal mucosa can be adequately visualized.

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