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• W2314503298 abstract "Introduction: First described by Cruveilhier in 1832, cecal ulcerations commonly present as right lower quadrant abdominal pain and massive bleeding, which may have multiple etiologies including irritable bowel syndrome, diverticulitis, and non-steroidal anti-inflammatory drug (NSAID) use. A significant number diagnoses are made incidentally via endoscopy, and may require surgical intervention. 55-year-old man was transferred to our institution from another facility with complaints of painless hemodynamically significant hematochezia. His medical history was significant for chronic peripheral vascular disease status post right iliac artery stent for which he was taking Clopidogrel, Aspirin, and Cilostazol. Personal history included chronic alcohol use in moderation and tobacco use. No family history of any inherited coagulopathy or gastrointestinal malignancy. Prior to transferring the patient to our intensive care unit, the patient was transfused with blood and Intravenous (IV) fluids in an attempt to stabilize him hemodynamically. Esophagogastroduodenoscopy (EGD) and colonoscopy were also performed but could not pin point the source of bleeding. His clinical deterioration and persistent active bleeding necessitated transfer to our hospital for a higher level of care. We continued with aggressive IV hydration and blood product support. Repeat EGD revealed mild gastric erythema while the tagged RBC scan demonstrated active bleeding throughout the transverse colon extending to the rectosigmoid junction. Finally, the colonoscopy showed multiple bleeding cecal ulcers including one with a visible vessel. Epinephrine was injected and hemostatic clips were placed to secure adequate hemostasis at the visible vessel site. Post procedure, the patient did not have any fresh episodes of bleeding. His anti platelet agents were with held for two weeks after adequate risk assessment and informed decision making on behalf of the patient regarding potential of stent stenosis. Colonic mucosal injury secondary to Aspirin/ NSAID use is responsible for around ten percent of cecal ulcers, as was the case in our patient. If promptly identified, conservative approach with withdrawal of offending agent is as effective as the more aggressive surgical option with advantage of shorter hospital stay and decreased morbidity. This case also demonstrated that patients with cecal ulcers may present with atypical symptoms such as hematochezia with no abdominal pain or discomfort. An unremarkable EGD or colonoscopy initially, may not rule out cecal ulcerations, and a repeat endoscopic examination is warranted, certainly in patients with persistent bleeds." @default.
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• W2314503298 date "2013-12-01" @default.
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• W2314503298 title "1276" @default.
• W2314503298 doi "https://doi.org/10.1097/01.ccm.0000440508.36680.30" @default.
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