A 56-year-old woman presented to our hospital with a sudden onset of hematochezia. A blood examination showed a normal hemoglobin level of 12.1 g/dL. Urgent colonoscopy revealed a protruding lesion with a large ulcer in the ascending colon near Bauhin's valve. Lavage of the lesion revealed spurting bleeding from an exposed vessel at the base of the ulcer (Picture 1). The hemorrhage was successfully suppressed by endoscopic clipping (Picture 2). Right hemicolectomy was performed nine days after the suppression of the bleeding. The post-endoscopy and postoperative course was uneventful. A pathological analysis of the surgical specimens confirmed a moderately differentiated tubular adenocarcinoma. In one of the slices, which had been subjected to Weigert and hematoxylin-eosin staining, a small artery which ran under the ulcer floor was observed. This artery was thought to be responsible for the bleeding (Picture 3).
Picture 1.
Picture 2.
Picture 3.
Spurting hemorrhage is a rare entity in patients with colon cancer (1,2). Spurting hemorrhage should therefore be considered in the differential diagnosis of common clinical symptoms such as hematochezia.
The authors state that they have no Conflict of Interest (COI).
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