Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


38.1 Endoclipping of a bleeding rectal ulcer

A critically ill 44-year-old female develops bright red blood per rectum and hemodynamic instability. A rectal tube has been in place for management of diarrhea. On lower endoscopy a broad ulcer is seen in the rectum. After gentle washing and manipulation, a jet of blood spurts from the ulcer. An endoclip is deployed but placement is just proximal to the lesion and bleeding continues. Epinephrine injection is not used to help control the bleeding due to concern that it could distort the lesion and make it more difficult to approach. A second clip is advanced into the field of vision and rotated to achieve optimal positioning. The clip is deployed and hemostasis is achieved. Another possible non-bleeding visible vessel is seen within the ulcer. Additional clips are applied to close the ulcer.