A 62-year-old woman presented to the emergency department of our hospital with overt rectal bleeding.
The initial assessment showed clinical and hemodynamic stability, with anodyne physical examination except for rectal examination, which was very painful and with the presence of rectal blood.
Hemoglobin and hematocrit were within the normal range, while there was an overdose of coumarins with INR: 6.3.
As an immediate antecedent, she emphasized that the patient had presented, in the previous days, a flu condition that was being treated symptomatically.
The day before your consultation, you reported having given a suppository of diclofenac.
Despite the correction of coagulation disorders with vitamin K and plasma administration, a quantitative rectal bleeding persisted, which nested the patient and concentrated the transfusion of two units.
A tapering was performed, which showed a deep, about 7-8 cm from the anal margin, irregular edges, in which muscle and aponeurotic tissue appeared to be appreciated.
Subsequently, the patient should be submitted to a CT scan, which confirmed the suspicion of rectal perforation and also showed a 6.5 cm diameter perirectal hematoma with air bubbles in relation to it.
1.
Diagnosis: rectal ulcer perforated to presacral space in relation to diclofenac suppository treatment.
In coordination with the surgery service of our hospital, an expectant attitude was decided, progressively improving the patient's pain and the feeling of perineal occupation and disappearing rectal bleeding on subsequent days.
