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Background Red dichromatic imaging (RDI) is a novel image-enhanced endoscopy expected to improve the visibility of the bleeding point. However, it has not been thoroughly investigated. Case summary A 91-year-old man developed a sudden massive hematochezia and underwent emergent colonoscopy. An ulcer with pulsatile bleeding was found on the lower rectum. Due to massive bleeding, the exact location of the bleeding point was not easy to detect with white light imaging (WLI). Upon switching to RDI, the bleeding point appeared in deeper yellow compared to the surrounding blood. Thus, RDI enabled us for easier recognition of the bleeding point, and hemostasis was achieved successfully. Furthermore, we reviewed endoscopic images and evaluated the color difference between the bleeding point and surrounding blood for WLI and RDI. In our case, the color difference of RDI was greater than that of WLI (9. 75 vs 6. 61), and RDI showed a better distinguished bleeding point from the surrounding blood. Conclusion RDI may improve visualization of the bleeding point by providing better contrast in color difference relative to surrounding blood.

Objective Endoscopic band ligation (EBL) is commonly performed to treat colonic diverticular bleeding (CDB). However, EBL is not suitable for other disorders that cause acute lower gastrointestinal bleeding (ALGIB), and the safety and efficacy of the procedure are not well known. This study aimed to evaluate the efficacy and safety of EBL for non-colonic diverticular bleeding (non-CDB) and investigate the application of EBL to ALGIB. Methods This study was a retrospective evaluation of the success rate of EBL, the rate of early re-bleeding (within 30 days of the initial EBL), and complications such as perforation and abscess formation. Patients Thirty patients who presented with non-CDB and underwent EBL as the first-line treatment in our hospital from June 2009 to December 2017 were included in the present study. Results The success rate of EBL was 93% (28/30). The rate of early re-bleeding after EBL was 20% (6/30). Repeat EBL, endoscopic clipping, or conservative therapy was performed in the event of re-bleeding. No emergency surgery or interventional hemostatic treatments were required for hemostasis. No complications such as perforation or abscess formation were observed in any patient. Conclusion Our results suggest that EBL is an effective and safe endoscopic treatment for non-CDB.

We experienced two cases in which manual compression hemostasis under endoscopic observation was used in patients with acute hemorrhagic rectal ulcer (AHRU). The patients experienced an episode of massive fresh hematochezia, requiring the blood transfusion. Emergent sigmoidoscopy revealed multiple ulcers with a large protuberant visible vessel or with gush-out hemorrhage on the lower rectum. Endoscopic hemostasis by hemoclips and hypertonic saline-epinephrine injection was attempted; however, mechanical mucosal injury induced by hemoclips and needles caused another gush-out hemorrhage. Thus, the site of bleeding was manually compressed by a forefinger under endoscopic observation. After 5 min, compression hemostasis was achieved, and the postoperative course was uneventful. Manual compression hemostasis under endoscopic observation is useful and worth attempting for AHRU.

Background: Previous infectious or inflammatory events may be involved in the pathogenesis of neuromyelitis optica (NMO), potentially by triggering an autoimmune response. Cytomegalovirus (CMV)-related NMO (CMV-NMO) is rarely reported. Acute hemorrhagic rectal ulcer (AHRU) is a rare disease with a largely unknown pathogenesis. Herein, we reported a co-NMO and AHRU case associated with CMV infection. In addition, we review previously reported cases of CMV-NMO and CMV-AHRU. Case presentation: A 40-year-old female diagnosed with aquaporin4 (AQP4)-IgG+ NMO and a poor response to high-dose intravenous methylprednisolone and immunoglobulin, followed by three rounds of plasma exchange was transferred to Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. She developed repeated acute lower gastrointestinal hemorrhage from the third day of admission. Abdominal computed tomography angiography (CTA) and interventional angiography did not detect any bleeding vessel. Bedside colonoscopy revealed a large ulcer-like lesion at 10 cm above the anus. Rectal biopsy pathology confirmed a CMV infection on day 23 post-admission, and cerebrospinal fluid (CSF) pathogen gene sequencing detected CMV gene copies on day 25 post-admission. After 2 weeks of treatment with ganciclovir and sodium phosphinate, the patient's lower gastrointestinal bleeding stopped, and her limb muscle strength and visual acuity gradually improved. After 4 weeks of antiviral therapy, colonoscopy showed that the intestinal wall of the original lesion was smooth. Hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) of a biopsy specimen was negative for CMV, her right eye vision was normal, and limb muscle strength had recovered. Serum AQP4-IgG was negative, and lesions on brain magnetic resonance imaging (MRI) manifested shrinkage. Conclusions: The benefits of antiviral therapy remain unclear; however, clinicians should be aware of the possibility of CMV-related NMO, if NMO was refractory to high-dose intravenous methylprednisolone, immunoglobulin, and plasma exchange. Moreover, clinicians should consider the possibility of CMV-related AHRU when recurrent acute lower gastrointestinal bleeding occurs in a patient.

Introduction Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). Methods A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. Results AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. Conclusion AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.

Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless massive bleeding from rectal ulcers, usually in patients who have severe underlying disorders. The rate of recurrent bleeding from AHRU is high, but there have been few studies on the risk factors for recurrent bleeding. The aim of this study was to identify risk factors for recurrent bleeding from AHRU.Among 27,151 patients who underwent colonoscopy from 2006 November to 2017 March in our hospital, 120 patients with AHRU were retrospectively reviewed to identify risk factors for recurrent bleeding. Factors analyzed were: age, sex, Charlson Comorbidity Index (CCI), comorbidities (congestive heart failure, liver cirrhosis, renal failure, respiratory failure, diabetes mellitus and malignancy), medications (antiplatelet drugs, anticoagulants and steroids); endoscopic therapy and endoscopic features of AHRU.Recurrent bleeding from AHRU occurred in 30% of patients (36/120). In multi-variate analysis, individual comorbidities, medications, endoscopic features and endoscopic hemostasis were not significant or independent risk factors for recurrent bleeding. However, a high CCI score (4 or more) was a risk factor (odds ratio, 7.0; 95% confidence interval, 1.8-27.1). Endoscopic hemostasis was performed in 61% (73/120) of AHRU patients, and successful hemostasis was achieved in 99% of the treated patients (72/73).High CCI score was a predictor of recurrent bleeding from AHRU, but individual comorbidities, medications, endoscopic features or endoscopic hemostasis were not. Endoscopic hemostasis for bleeding from AHRU was achieved in most patients, but the recurrent bleeding rate was high.

Background: Acute hemorrhagic rectal ulcer (AHRU) can be found in patients with severe comorbid illness, who are bedridden for a long time. Per anal suturing is a quick and feasible treatment. However, recurrent bleeding occurs frequently after suture ligation of a bleeder and can be life-threatening. However, the risk factor for recurrent bleeding is not well known. Our study tries to clarify the risk factor of repeat AHRU in Intensive Care Unit (ICU) patients. Materials and Methods: From January 2004 to December 2009, the medical records of 32 patients, who were admitted to the ICU of the Tri-Service General Hospital, a tertiary referral center in Taiwan, and who underwent per anal suturing of acute hemorrhagic rectal ulcer were retrospectively reviewed. Results: Of the 96 patients who received emergency treatment for acute massive hematochezia, 32 patients were diagnosed with AHRU. Eight (25%) patients had recurrent bleeding following suture ligation of AHRU and underwent a reoperation; no patient had recurrent bleeding after the second operation. The duration from the first hematochezia attack to surgery ( P = 0.04), liver cirrhosis ( P = 0.002), and coagulopathy ( P = 0.01) were the risk factors of recurrent bleeding after suture ligation of a bleeder. Multivariate logistic regression analysis indicated that liver cirrhosis (OR = 37.77, P = 0.014) was an independent risk factor for recurrent bleeding. Conclusion: AHRU could be a major cause of acute massive hematochezia in patients with severe illness. Our data showed that per anal suturing could quickly and effectively control bleeding. We found that liver cirrhosis was an independent risk factor for recurrent bleeding. Therefore, treatment of a liver cirrhosis patient with AHUR should be more aggressive, such as, early detection and proper suture ligation.

【目的】急性出血性直腸潰瘍は長期臥床の高齢者に多い疾患であるが, がん患者での報告は少ない. 今回, 対麻痺の肺がん患者に合併した急性出血性直腸潰瘍の1例を報告する. 【症例】40歳代の男性. 肺がんの脊髄浸潤により対麻痺を発症し, 緊急入院となった. 第25病日より無痛性の新鮮血下血が始まり, 出血量が増加した. その後, 下部消化管内視鏡検査を施行し, 下部直腸に潰瘍性病変と露出血管を認めた. 臨床症状と内視鏡所見より急性出血性直腸潰瘍と診断し, ただちにクリッピング術を行った. その後は下血の再燃を認めず, 第103病日に退院となった. 【結論】急性出血性直腸潰瘍は終末期がん患者でも治癒しうる病態であり, 症例によって迅速な診断と治療が必要である. Palliat Care Res 2011; 6(1): 308-312

症例1は72歳女性で主訴は赤黒い血便であった．心不全治療のため当院循環器科入院中に貧血精査目的で施行した上部消化管内視鏡検査で胃角部に地図状潰瘍を認め，露出血管に対する止血処置を行った．その後，赤黒い血便を認め大腸内視鏡検査を施行した．直腸に急性出血性直腸潰瘍を認め露出血管を凝固止血した．直腸潰瘍底から生検を行ったところ免疫染色でサイトメガロウイルス感染が証明された．ガンシクロビル投与にて直腸潰瘍の著明な縮小を認めた． 症例2は68歳男性で主訴は黒色便であった．多発胃潰瘍および急性出血性直腸潰瘍を認めた．潰瘍底からの生検標本でサイトメガロウイルス感染が証明された． 2症例ともに，胃と直腸に同時に潰瘍が合併し，直腸潰瘍底からサイトメガロウイルスが証明された．胃潰瘍底からはサイトメガロウイルス感染は証明できなかった．長期臥床が原因で急性出血性直腸潰瘍を呈する症例はしばしば経験されるが，本症例のようにサイトメガロウイルス感染が証明された報告は極めて稀である．正常免疫患者であっても急性出血性直腸潰瘍ではサイトメガロウイルス感染を疑う必要がある．

症例は41歳男性．既往歴に特記すべき事なし．1週間程前より黒色便を認めていたが放置していた．2009年9月下旬，鮮血下血を主訴に救急外来受診．嘔気や腹痛などの腹部症状は認めなかった．同日施行した下部内視鏡検査では下部直腸3時方向に出血源を疑う病変を認めたが，観察時自然止血されており経過観察入院とした．入院第2病日，再度下血を認めたため内視鏡検査を行ったところ，下部直腸に露出血管をともなう深掘れ潰瘍を認め，経肛門的に縫合止血術を施行した．止血術後，第9病日再下血を認め再度の経肛門的縫合止血術を施行した．術後は経過に問題なく第24病日退院となった．急性出血性直腸潰瘍（AHRU）は長期臥床の高齢者に多く発症するとされるが，今回我々は基礎疾患のない壮年男性に発症した出血性直腸潰瘍を経験した．AHRUには病因・病態を考慮する上で従来の概念に当てはまらない広義のAHRUがあり，今後疾患概念の確立が必要である．

症例は71歳, 男性. 糖尿病性慢性腎不全で血液透析維持中に下肢閉塞性動脈硬化症悪化で入院し, 突然の大量血便を生じた. 大腸ファイバースコピーで直腸に, 底部露出血管から拍動性出血持続の潰瘍病変を認め, 急性出血性直腸潰瘍 (acute hemorrhagic rectal ulcer, 以下AHRU) と思われた. 当初の出血はclippingで止血したが, 2日後に再出血し, 腰椎麻酔下, 経肛門的に病変周囲の刺通結紮止血術を行った. 以後も出血が反復し, 最終的には止むを得ず, 腹会陰式直腸切断術を施行した. 手術直後は順調な経過であったが, 術後5日目に肺梗塞を併発し, 翌日に永眠された. AHRUは比較的稀な疾患とされ, その発症には種々の基礎的因子が関与し, それらは手術侵襲へのリスクでもある. したがって, 同病変の止血には種々の局所的処置が主体とされているが, 今回, 止血がきわめて困難で直腸切断術を選択した1症例について報告した.

Acute hemorrhagic rectal ulcer (AHRU) has increasingly been reported in Japan, whereas it has rarely been reported in the English literature and is not yet established as a disease entity. The aim of this study was to elucidate clinical and endoscopic characteristics of patients with AHRU.We enrolled 20 patients with 26 ulcers diagnosed as AHRU in our department between January 2001 and October 2005. Clinical features such as the underlying disorder, Karnofsky performance status (PS), and presence or absence of anticoagulant or antiplatelet therapy, as well as endoscopic findings and type of bleeding, were evaluated. Strategies for hemostasis were also reviewed.The most prevalent underlying disorder was diabetes mellitus, and the number of bedridden patients with PS 4 was relatively high. In addition, more than half of the patients had been treated with anticoagulant or antiplatelet agents. Endoscopically, ulcers were characteristically solitary and irregularly shaped, and they did not show any typical localization pattern. As a hemostatic strategy, clipping alone showed a favorable result, with a hemostatic success rate as high as 76.9%.This study may support the establishment of AHRU as a new clinical entity. In aged patients being treated with anticoagulant or antiplatelet agents, especially bedridden patients using aspirin, the possible appearance of this disease should be kept in mind.

PURPOSE: Acute hemorrhagic rectal ulcer syndrome is characterized by sudden onset, painless, and massive hemorrhage from rectal ulcer(s) in patients with serious underlying illnesses. It is a matter of controversy whether acute hemorrhagic rectal ulcer syndrome is a distinct clinical entity. This is the first Asian report on acute hemorrhagic rectal ulcer syndrome to be made outside Japan. METHODS: From January 1989 to December 1999, 8,085 patients underwent total colonoscopy at our institution. We retrospectively analyzed the medical records and colonoscopic files. The diagnosis of acute hemorrhagic rectal ulcer syndrome was made by means of the clinical, histologic, and colonoscopic findings. RESULTS: Among the 8,085 patients, 19 patients (11 males; mean age, 71.2 ± 10.1 years) were diagnosed with acute hemorrhagic rectal ulcer syndrome, which accounted for 2.8 percent of the patients with massive lower gastrointestinal bleeding. The duration from hospitalization to the onset of massive bleeding ranged from 3 to 14 (mean, 9 ± 3.3) days. Characteristics of colonoscopic appearance were solitary or multiple rectal ulcer(s), with round, circumferential, geographical, or Dieulafoy-like lesions located within a mean of 4.7 cm ± 1.5 cm from the dentate line. Histopathologically, the lesions appeared as necrosis with denudation of covering epithelium, hemorrhage, and multiple thrombi in the vessels of the mucosa and underlying stroma, which is considered to be similar to stress-related mucosa injury. Successful hemostasis was obtained in 74 percent (14/19) of patients with direct therapeutic maneuvers. Prognosis was largely dependent on accurate diagnosis and management of the underlying disorders. CONCLUSIONS: We assert that acute hemorrhagic rectal ulcer syndrome is a rare but important entity and stress that awareness of this clinical entity should lead to a high index of suspicion resulting in early detection, diagnosis, and appropriate therapy.

A 65-year-old man visited our hospital on November 8, 2000 because of pain in the right cheek mucosa. He had diabetes mellitus and hypertension and was a carrier of hepatitis B virus. After excision of the tumor, right conservative neck dissection and microvascular reconstruction with a free rectus abdominis muscle flap, he received ventilatory assistance for 3 days. He was given antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative pneumonia and a wound infection. On 17th postoperative day, the hemoglobin level suddenly decreased from 9.5g/dl to 8.0g/dl over the course of 2 days. Gastrointestinal examination showed no bleeding points. A new episode of massive bleeding occurred on the 21st day. The bleeding point could not be identified by colonoscopicexamination, radioisotope angiography, or angiography of the artery. However, a wide shallow ulcer of the rectum was finally found 2cm from the anal verge on another colonoscopic examination on the 28th day. The AHRU in this patient might have been caused by postoperative stress, a large dose of NSAIDs, underlying disease, or a combination of these factors.

症例は80歳, 女性, 主訴は下血.糖尿病, 脳出血後遺症で当科加療中, 平成6年11月から平成7年10月までの約1年間に5回にわたる突然の無痛性大量下血で入退院を繰り返した.下血発症時にはいずれも肛門輪直上の下部直腸に浅い潰瘍性病変が観察され, 形状は不整地図状, 小型類円形, Dieulafoy型と多彩であった.保存的治療や内視鏡的止血術にて5回とも速やかに止血し, そのたびに直腸潰瘍も瘢痕化して治癒した.再発を繰り返し再出血が危惧されるため手術適応と判断し, 平成7年10月12日に直腸局所切除, 人工肛門造設術を施行した.組織像は中等度の非特異性炎症所見を伴う上皮欠損であった.臨床経過と内視鏡所見および組織像から急性出血性直腸潰瘍と判断した.本疾患の手術適応は少ないが, たびたび再発を繰り返すため最終的に手術を要したまれな1例であった.

症例は62歳の女性.脳動脈瘤の破裂によるクモ膜下出血と診断され,動脈瘤クリッピング術後第5病日に突然に下血が出現し,さらに4日後に大量下血がみられた.内視鏡にて下部直腸の後壁側,歯状線より3cm口側に,湧出性の出血を伴う血管の露出を認め,地図状の浅い潰瘍性病変を認めた.エタノールの局注にて止血しえたが,再出血をきたした.ショック状態となったため,緊急直腸切断術を行い救命しえた.病理組織学的には急性潰瘍の像を呈し,上皮細胞が完全に脱落し,筋層を越える組織欠損を伴い,リンパ球,好中球,形質細胞などの炎症性細胞の浸潤を認めた.また潰瘍近傍の小動脈には血栓形成や血管壊死性の変化を認めた.本症例は脳障害による中枢性のストレスが主な発生原因と考えられた.

The occurrence of acute hemorrhagic rectal ulcer (AHRU) in patients in the intensive care unit (ICU) has not been well investigated. The aims of this study were to evaluate the clinical manifestations and outcomes in these patients.The patients developing significant acute lower gastrointestinal (LGI) bleeding after ICU admission from July 2002 to December 2007 were retrospectively reviewed. Bedside colonoscopy was performed within 24 h of bleeding, and those patients with bleeding from AHRU were studied. Ulcers with stigmata of recent bleeding were treated with endoscopic hemostasis, and the outcome of these patients was analyzed.AHRU occurred in 36 of 114 patients (31.6%) and was the most common cause of acute LGI bleeding after ICU admission. Most patients had comorbidities, such as respiratory failure, renal failure, diabetes mellitus, or atherosclerosis. Fourteen patients (38.9%) developed hypovolemic shock after the onset of bleeding. Endoscopic therapy was performed in 29 patients with 97.2% success rate for hemostasis. Fourteen patients (48.3%) developed rebleeding within 4 weeks. This was controlled by repeated endoscopic intervention. Anticoagulant use was the risk factor for rebleeding after treatment. The survival rate at 4 weeks after bleeding was 52.8%. Logistic regression analysis revealed thrombocytopenia (platelet count150,000/mm(3)) and more than one comorbidity were independent predictors for mortality.AHRU is an important etiology of acute LGI bleeding in the patients with critical illness. Bedside colonoscopy is helpful for early diagnosis and treatment. The underlying comorbidities of the patients influence the outcome after bleeding.

An acute hemorrhagic rectal ulcer (AHRU) is considered to be a potentially life-threatening illness requiring urgent identification and management because of massive bleeding. It is therefore important to clarify the factors associated with the massive bleeding of an AHRU and the best management. The factors associated with the massive bleeding of 14 patients with AHRU were determined by comparing the clinicopathologic features, laboratory data, and treatment between four patients with more transfusions (≥12 U) and 10 patients with less transfusions (≤3 U). Patients with AHRU of the more transfusion group had lower performance status (PS), more diabetes mellitus, more comorbid diseases, and lower serum albumin concentrate than those of the less transfusion group. More surgical treatment and the administration of hemostatic agents were necessary for the patients with AHRU of the more transfusion group than for those of the less transfusion group, and the duration from bleeding to hemostasis in patients with AHRU of the more transfusion group was larger than that of the less transfusion group. Patients with AHRU of the more transfusion group had a longer duration of no oral food intake, total parenteral nutrition, and hospital stay from bleeding day than those of the less transfusion group. Thus, the factors associated with the massive bleeding of AHRU were identified.

症例は49歳,男性.1992年7月会社で作業中,突然無痛性の新鮮下血が出現したが自然止血した.大腸内視鏡検査では,歯状線近傍直腸後壁を中心として帯状に多発する浅い地図状不整形潰瘍を認めた.生検組織検査では,粘膜に軽度の繊維化を認めたが,炎症細胞浸潤はほとんどなく,特異的炎症所見は認めなかった.出血以外に自覚症状はなく,重症基礎疾患や発症誘因は認めなかった.23,38,43,46歳時に今回と同様の下血があったが,いずれも自然止血し,今回同様の病変によると思われる.本症例のように,再発を繰り返した,いわゆる"急性出血性直腸潰瘍"は本邦に報告例がなく,稀な1例と思われるので報告する.

Background Acute hemorrhagic rectal ulcer (AHRU) occurs suddenly with painless, massive, fresh rectal bleeding in elderly, bed-ridden patients who have a serious primary disease. There have been several reports on AHRU in Japan, but in Western countries, there have been none. We examined the clinical characteristics of four cases, and we report on AHRU in Western countries. Study The medical records and endoscopic findings in four patients with AHRU seen during a 3-year period were reviewed. The diagnosis of AHRU was established by clinical symptoms, endoscopic examination, and other methods. Results All of the patients were elderly and bed-ridden and all had sudden onset of massive, fresh rectal bleeding without pain. Sigmoidoscopic examination of all patients showed a shallow or irregular bleeding ulcer in the lower rectum. In three cases, the clinical course was uneventful. In the other case, massive, fresh rectal bleeding recurred but transanal ligation was effective. Conclusions When painless, massive, fresh rectal bleeding occurs in elderly and bed-ridden patients, it is important to carefully examine the lower rectum, as there is a strong possibility of AHRU.

음 발표되기 시작하였으며 1990년대에 증례 보고가 증가하면서 점 차 증후군 형태로 진단되기 시작하였다. 주로 일본을 중심으로 보고 되었던 이 질병은 2000년대에 들어오면서 서양에서도 입원 환자 및 중환자실 환자에서의 하부위장관 출혈 원인으로 분류되기 시작하였 다. 점차적으로 복합 기저질환 환자의 생존 기간이 연장되면서 급성 출혈성 직장 궤양이 하부위장관 출혈의 주요 원인으로 보고되고 있 고, 진단이 증가하고 있어 이 질환에 대한 중요성 또한 높아지고 있 다. 최근에는 국내에서도 급성 출혈성 직장 궤양 환자에 대한 단순 증례 보고 뿐 아니라 이에 대한 임상적 내시경적 특징 및 재출혈 위험 인자에 대한 보고가 있었다. 그러나, 적은 환자수의 후향적인 연구이 고 예후에 대한 구체적인 연구가 아직 없었다. 이에 저자들은 급성 출 혈성 직장 궤양 환자들의 기본적인 임상적 특징을 확인하고 더불어 재출혈 및 입원기간 중 사망의 위험 요인을 분석하여 해당 질환 발생 The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer

A case of acute hemorrhagic rectal ulcer complicating cerebral infarction is reported. the patient was a 75-year-old male, transferred from another hospital, with massive rectal homorrhage complicating cerebral infarction. Acute selective angiography revealed a pooling of contrast material in the left branch of the superior rectal artery. Colonofiberscopy demonstrated pulsating fibrinoid coagula at 3 O'clock direction in the rectal wall 3.5cm proximal to the anal verge. With ligation of the superior rectal artery together with resection of the ulcer, acitve bleeding discontinued. Microscopical findings showed a UL-II-type ulcer with inflammatory cell infiltration and thickening of the arterial wall. Rectal ulcers with acute massive hemorrhage compllcaing brain diseases or severe illnesses have been reported. Kawano called this lesion acute hemorrhagic rectal ulcer in 1980. There are 45 cases (including ours) of rectal ulcers like this lesion reported in the literature. With reference to these reports we discuss particularly the clinical picture.