• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.15-22
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• 2008

Rectal bleeding is a common and worrisome problem in pediatric practice. The condition is usually alarming to patient and children. Although most cases are benign and self-limited, sometimes serious pathology also present in this manner. And severe rectal bleeding necessitates prompt diagnostic notice and appropriate treatment. The etiologies of rectal bleeding are somewhat specific to certain age group in children. Accurate history and through physical examination are paramount importance to help differentiate of the diverse etiologies causing rectal bleeding in children. This review describes patterns of rectal bleeding, historical and physical aspect, differentiation of clinical characteristics of rectal bleeding according to etiology, and diagnostic investigations.

• Clinical and Experimental Pediatrics
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• v.56 no.12
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• pp.514-518
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• 2013

The etiology of small and fresh rectal bleeding in neonates who are not sick is usually unknown; the only known cause is food protein-induced proctocolitis (FPIPC). It has been recently reported that FPIPC is a rare cause of rectal bleeding in newborns, and most cases have been proved to be due to idiopathic neonatal transient colitis. A recommended strategy for diagnosing suspected FPIPC in neonates is as follows. During the early stage, the etiology of small and fresh rectal bleeding in an otherwise healthy newborn need not be studied through extensive investigations. In patients showing continued bleeding even after 4 days, sigmoidoscopy and rectal mucosal biopsy may be performed. Even if mucosal histological findings indicate a diagnosis of FPIPC, further oral food elimination and challenge tests must be performed sequentially to confirm FPIPC. Food elimination and challenge tests should be included in the diagnostic criteria of FPIPC.

• The Journal of Korean Medicine
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• v.35 no.4
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• pp.116-122
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• 2014

Objectives: Rectal cancer bleeding occurs approximately 20% of overall rectal cancer patients. The current standard treatments cannot cover minor bleeding enough. Failures of the local or systemic approaches to stop bleeding are frequently reported. Methods: we reported a case of male rectal cancer patient who was treated with herbal decoction and significantly improved on symptoms, such as, loose stools and rectal bleeding. Previous to first visiting to our clinic, he was prescribed to use oral tranexamic acids, which failed to relieve his symptoms. He was administered with an herbal decoction, Inhyungtang, clinically known to have hemostastic effect in hematochezia. Results & Conclusion: The prescription showed significant improvement on his symptom, in particular, his bleeding. Thus, we report his case and we expect further experiences and experimental studies to support efficacy of Inhyungtang.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.343-352
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• 2002

Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.

• Journal of Yeungnam Medical Science
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• v.34 no.1
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• pp.88-90
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• 2017

Although Dieulafoy lesion can occur in any part of the gastrointestinal tract, its occurrence in the rectum is rare. Rectal Dieulafoy lesions have been associated with advanced age, renal failure, burns, liver transplantation and cirrhosis. Here, we report on a case of massive bleeding from a rectal Dieulafoy lesion after lung decortication surgery in a 57-year-old male patient with alcoholic cirrhosis. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive lower gastrointestinal bleeding in a patient with cirrhosis.

• Radiation Oncology Journal
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• v.21 no.4
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• pp.276-282
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• 2003

Purpose: Although high-dose-rate intracavitary radiotherapy (HDR ICR) has been used in the treatment of cervical cancer, the potential for increased risk of late complication, most commonly in the rectum, is a major concern. We have previously reported on 136 patients treated with HDR brachytherapy between 1995 and 1999. The purpose of this study is to upgrade the previous data and confirm the correlation between late rectal complication and rectal dose in cervix cancer patients treated with HDR ICR. Materials and Methods: A retrospective analysis was peformed for 222 patients with cevix cancer who were treated for curative intent with external beam radiotherapy (EBRT) and HDR ICR from July 1995 to December 2001. The median dose of EBRT was 50.4 (30.6$\~$56.4) Gy with a daily fraction size 1.8 Gy. A total of six fractions of HDR ICR were given twice weekly with fraction size of 4 (3$\~$5.5) Gy to A point by Iridium-192 source. The rectal dose was calculated at the rectal reference point using the barium contrast criteria. in vivo measurement of the rectal dose was peformed with thermoluminescent dosimeter (TLD) during HDR ICR. The median follow-up period was 39 months, ranging from 6 to 90 months. Results: Twenty-one patients (9.5$\%$) experienced late rectal bleeding, from 3 to 44 months (median, 13 months) after the completion of RT. The calculated rectal doses were not different between the patients with rectal bleeding and those without, but the measured rectal doses were higher in the complicated patients. The differences of the measured ICR rectal fractional dose, ICR total rectal dose, and total rectal biologically equivalent dose (BED) were statistically significant. When the measured ICR total rectal dose was beyond 16 Gy, when the ratio of the measured rectal dose to A point dose was beyond 70$\%$, or when the measured rectal BED was over 110 Gy$_{3}$, a high possibility of late rectal complication was found. Conclusion: Late rectal complication was closely correlated with measured rectal dose by in vivo dosimetry using TLD during HDR ICR. If data from in vivo dosimetry shows any possibility of rectal bleeding, efforts should be made to reduce the rectal dose.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.1
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• pp.115-120
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• 2020

Klippel-Trenaunay syndrome (KTS) is a rare disorder characterized by a triad of abnormal bone and soft tissue growth, the presence of a port-wine stain, and venous malformations. Gastrointestinal (GI) manifestations of KTS are relatively common and generally do not cause significant problems. However, persistence can lead to chronic GI blood loss or even massive bleeding in rare cases. The majority of the severe GI manifestations associated with KTS present as vascular malformations around the GI tract and exposed vessels can lead to serious bleeding into the GI tract. Herein, we report a case of a 16-year-old boy with severe iron deficiency anemia who was previously misdiagnosed as hemorrhoid due to small amount of chronic bleeding. The actual cause of chronic GI bleeding was from an uncommon GI manifestation of KTS as rectal polyposis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.1
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• pp.10-15
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• 2009

Purpose: The manner of rectal bleeding of auto-amputated polyps (AP) is similar to juvenile polyps (JP) or Meckel's diverticula (MD). We conducted this study to characterize the clinical spectrum of AP. Methods: Fourteen patients were enrolled this study who were diagnosed AP due to painless rectal bleeding. The clinical data of AP was assessed and then compared with the clinical data of JP and MD retrospectively. Results: The prevalence of AP was 10.4% (14/135) and high in younger patients compared with that of JP (p=0.042 below 2 years). Whereas JP was more common in patients aged 2 to 5 years (p=0.005). Male was predominant in AP (p=0.008 AP vs JP). The manner of rectal bleeding in AP group was sudden and transient. There was no significant difference in time interval between onset of rectal bleeding and diagnosis between the 3 groups. However AP was diagnosed in 9 patients (64.3%) within 7 days after onset of rectal bleeding, but JP was diagnosed in 5 patients (4.1%) in the same period (p<0.001). All of AP were located in the rectum and the sigmoid colon. The mean hemoglobin was 11.3${\pm}$1.5 g/dL in AP, 11.8${\pm}$1.3 g/dL in JP, and 8.4${\pm}$1.2 g/dL in MD (p<0.001, only significant in MD). Conclusion: AP may be considered in male older than 1 year with transient and sudden onset or increase of painless rectal bleeding without drop of hemoglobin level.

• Journal of Pharmaceutical Investigation
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• v.39 no.5
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• pp.381-386
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• 2009

We previously showed that the water extracts of rice wine-baked Scutellaria baicalensis Georgi (RWBS) ameliorated colonic inflammation more than crude Scutellaria baicalensis (CS) after oral administration. The aim of this study is to compare the effect of rectal and oral administration of RWBS in the experimental colitis. Experimental colitis was induced in mice by daily treatment with 5% dextran sulfate sodium (DSS) in the drinking water for 7 days. Water was used as vehicle of oral administration, while Carbopol/PEG mucoadhesive gel was used as vehicle of rectal administration. RWBS and RWBS gel (RWBSG) were administered once per day for 7 days. RWBS and RWBSG significantly attenuated the disease activity index (DAI) calculated as the sum of scores of body weight loss, stool consistency and rectal bleeding. Furthermore, RWBS and RWBSG reduced the mucosal myeloperoxidase activity and COX-2 (cyclooxygenase-2) expression in colon tissue. Anti-inflammatory effect of CS on colonic inflammation was increased by baking with rice wine in both oral and rectal administration. Moreover, anti-inflammatory effects of oral administration on colonic inflammation was greater than those of rectal administration. Further study would be required for the development of intra-rectal formulation.

• The Journal of Korean Medicine
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• v.28 no.3 s.71
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• pp.108-115
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• 2007

Objectives : The purpose of this study was to investigate the effect of Sojukjeongwon-san (이하 SJJWS) on a rectal cancer patient. Methods : This clinical case was analyzed on a patient who was admitted on August 11th and discharged on September 7th, 2006. We recordedhis abdominal pain, urine, anal pain, bleeding, mucous stools, frequency and hardness and amount of the stools, weight, lab follow-ups and so on. Results : After the treatment, the chief complaints of the patient, such as rectal pain, bloody excrement, loss of weight, etc., had improved. Conclusion : In this study we suggest that SJJWS reduced symptoms for a rectal cancer patient and improved the patient's quality of life.