Hemorrhagic rectal ulcer caused by a deformity of the coccyx complicated by normal delivery

Journal of Gastroenterology

2003 Volume 38, Number 7, 681 - 683

Toshimichi Kaneki A1, Shigeru Koyama A1, Shuichi Wada A1, Yoshiaki Matsuda A1, Hiromitsu Mori A1, Akira Kuraishi A1, Toru Fujisawa A1, Akira Kawashima A2, Tomonobu Koizumi A2, Keishi Kubo A2

A1 Department of Internal Medicine Nagano Red Cross Hospital 5-22-1 Wakasato Nagano 380-8582 Japan

A2 First Department of Internal Medicine Shinshu University School of Medicine Matsumoto Japan

Abstract:

A 25-year-old woman delivered her first-born child weighing 3400 g by full-term normal delivery. Bloody stool developed 3 days after delivery. Colonoscopic examination revealed two linear ulcers parallel to the anal column on the posterior side of the rectal ampulla about 5 cm from the anal ring. Coagulated blood was detected at the ulcer bottom, suggesting the site of hemorrhage. Bowel rest in the absence of oral intake resulted in the disappearance of bloody stool. Three days later colonoscopic examination revealed improvement in the ulcer. There was no sign of constipation. A lateral pelvic radiograph showed that the apex of the coccyx was flexed anteriorly. The parturient canal may have physically pressed the rectum against the apex of the coccyx during delivery, causing mucosal injury. Only a few studies have reported the complication of a rectal ulcer due to injury during delivery. Furthermore, none of the previous studies has reported a rectal ulcer caused by deformity of the coccyx.

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