Acute rectal bleeding

Skin A serious cutaneous adverse reaction was recently linked to tranexamic acid in a patient with liver cirrhosis and acute rectal bleeding. A 67-year-old male was prescribed oral tranexamic acid, which partially resolved his symptoms. However, 10 days after treatment began a purplish rash appeared on the patient s trunk, which became confluent with blisters and epidermal necrosis over the following days. Tranexamic acid was suspended and a skin biopsy was found to be consistent with toxic epidermal necrosis (TEN). Resolution of the skin lesions was favourable with fluid replacement, oral prednisone and N-acetylcysteine, but after 2 weeks the patient died secondary to acute renal failure, respiratory infection and multiorgan failure. This is the first report of TEN that occurred in a patient being treated with oral tranexamic acid [66 ]. 

An acute colitis, different from pseudomembranous colitis, was observed in five patients taking penicillin and penicillin derivatives (133). There was considerable rectal bleeding. The radiographic findings were those of ischemic colitis (spasm, transverse ridging, thumbprinting, and punctuate ulceration). On sigmoidoscopy and biopsy, the mucosa was normal, except for an inflammatory cell infiltration in one case. Conservative treatment resulted in rapid remission. 

A 76-year-old woman with rectal bleeding underwent sigmoidoscopy after taking two sachets of sodium phosphate solution (Fleet Phospho-Soda ) and sodium phosphate enema (Fleet Ready-To-Use ) [83 ]. She was then given mesalazine for chronic active ulcerative cohtis and 2 days later developed acute renal insufficiency, with normocalcemia and mild hyperphosphatemia. Mesalazine was replaced with prednisolone enemas. Renal biopsy showed normal glomeruli but widespread tubular calcification with high phosphate content the tubules were dilated and the tubular epithelium was flattened, with minimal lymphocytic infiltration. 

Enemas may be necessary in acute and severe coma episodes, with highly constipated patients or in cases of massive gastrointestinal bleeding. Occasionally, a rectal... 

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