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Bleeding rectal ulcers
Apr 13, 2001

My wife has been dealing with this problem for a year now, and it appears we are no nearer to a solution. The first incident of rectal bleeding occurred Good Friday, 2000. Blood count about 10. Over the last 12 months, there have been 8 incidents. They seem to be occurring more frequently and more severely. Recent counts on admission has been as low as 8, before hydration, with blood pressure of 48 over 26. Several colonoscopies have been done, usually resulting in shots to stop the arterial bleeding (the blood loss occurs very quickly, usually within 30 minutes). The ulcers also appear in areas that are not over an artery, and the bleeding and clotting is slight. The ulcers do heal and then recur somewhere else, always in a range of 3-5 inches inside the rectum. One one rather severe incident the ulcers were remove by an elliptical incision. We have a second opinion done, who tested for celiac, ultrasound for abdominal circulation, and prolapse testing. All have come back negative. Now they are talking about surgery to remove the two-inch area that the ulcers seem to thrive in. This appears to me to a shot in the dark - why would this cause the ulcers to stop? I think this is an unnecessary procedure. Also, many of these symptoms appear to be consistent with HIV/AIDS in other Q/A's. Should I be concerned about that in addition to my wife's ulcers?

Response from Dr. Feinberg

I think there should be a reason why your wife has bleeding rectal ulcers, and am wondering why you didn't mention her having had biopsy and culture results from prior procedures. In people with HIV, both CMV and Herpes viruses can cause ulcers that bleed. It probably wouldn't be unreasonable for her to get an HIV test, but ulcerative colitis, Crohn's disease and other causes seem more likely. I think she should know why this is happening before she submits to having such an opration. What if the problem will recur after surgery? Ask some hard questions aabout what has been done and what is left to do to sort this out before proceeding. Good luck!

Crohn's disease versus herpes

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