Acute Hemorrhagic Rectal Ulcer in a Uremic Patient: A Case Report and Literature Review.

Background: Acute hemorrhagic rectal ulcer (AHU) is a rare but severe cause of painless lower GI bleeding, mainly in elderly patients with comorbidities. Uremia increases bleeding risk due to platelet dysfunction and hemodialysis anticoagulation, but AHU in dialysis patients is underreported.

Aims: To report a case of AHU in a uremic hemodialysis patient and analyze management challenges.

Materials and methods: A 78-year-old female with ESRD presented with rectal bleeding. Colonoscopy showed a 3 × 4 cm ulcer, managed with clips, injections, and adhesives.

Results: The patient experienced recurrent bleeding, requiring multiple endoscopic interventions (titanium clip placement, methylene blue-polydocanol injection, tissue adhesive). Despite initial hemostasis, she developed worsening heart failure and multi-organ failure, dying at home after ICU admission.

Discussion: Uremia, anticoagulation, and comorbidities fueled bleeding. Endoscopic therapy was key, but systemic decline dominated. Multidisciplinary care is vital for high-risk patients.

Conclusion: This case instills awareness of the exigency regarding continuous observation and tailored management in this population of patients with high risk.