Stercoral Ulcers with Visible Vessel Presenting as Massive Lower Gastrointestinal Bleeding

Background: Lower gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality, with incidence rising with age. Stercoral ulcers, which are mucosal lesions in the colon or rectum, develop due to pressure from hardened or impacted fecal material. They primarily occur in elderly individuals with chronic constipation, dementia, or prolonged immobility, though they may also affect younger patients with psychiatric disorders. These ulcers can lead to bleeding or even perforation. While stercoral ulcers typically present with mild bleeding, massive GI haemorrhage is a rare but serious complication. Only a few reported cases describe stercoral ulcers with a visible vessel causing life-threatening lower GI bleeding. Case presentation: A 65-year-old woman with a history of hypertension, type 2 diabetes mellitus, and a recent ischemic stroke (resulting in left hemiparesis) on antiplatelet therapy presented with worsening chronic constipation and acute onset hematochezia. On examination, fecal impaction was suspected. Initial management with fluid resuscitation, blood transfusion, and manual fecal disimpaction was done. Subsequent sigmoidoscopy revealed multiple rectal ulcers of varying shapes and sizes, with one ulcer exhibiting a non-bleeding visible vessel. The lesion was successfully treated with endoscopic gold probe electrocoagulation, followed by haemostatic clip application to secure the vessel. The patient had no further bleeding episodes post-intervention. Conclusion: This case underscores the importance of proactive constipation management in elderly, bedridden patients, particularly those with multiple comorbidities and on antiplatelet therapy. Early recognition and intervention for stercoral ulcers are essential to prevent life-threatening complications such as massive gastrointestinal hemorrhage or perforation. Endoscopic therapy, including electrocoagulation and clipping, can be an effective approach for achieving hemostasis in such scenarios.