S5365 Stercoral Ulcer Bleeding Control via Band Ligation: A Case Report

Introduction: Endoscopic band ligation (EBL) is a well-established technique for achieving hemostasis in gastrointestinal (GI) bleeding. Commonly used for esophageal varices, EBL is favored over sclerotherapy due to superior efficacy and fewer complications. In recent years, its application has expanded to non-variceal GI bleeding, including angiodysplasia, Dieulafoy lesions, and refractory rectal ulcers—particularly when conventional methods like epinephrine injection or thermal therapy fail. EBL offers a minimally invasive, technically straightforward option with a favorable safety profile, though it requires precise lesion localization and monitoring for delayed complications such as ulceration, hemorrhage, or perforation. Case Description: An 81-year-old man presented due to ongoing rectal bleeding. The patient had recently been hospitalized for 5 weeks following hip fracture repair. During the prior admission, he experienced lower GI bleeding, and CT imaging was suspicious for stercoral colitis. On readmission, the patient reported persistent rectal bleeding, with hemoglobin dropping to 7 g/dL. Colonoscopy revealed a bleeding rectal ulcer, and initial hemostasis was achieved with 3 endoclips and epinephrine injection. Despite this intervention, the patient experienced recurrent bleeding. A follow-up flexible sigmoidoscopy demonstrated an ulcer without clot. Persistent bleeding prompted an attempted endoscopic band ligation (EBL), with 3 bands placed during sigmoidoscopy. However, bleeding recurred, and a subsequent flexible sigmoidoscopy again demonstrated a distal rectal ulcer, which was treated with additional epinephrine injection. Over the course of hospitalization, he underwent 3 flexible sigmoidoscopies with a combination of epinephrine injections and EBL, with eventual hemostatic success. Discussion: Despite multiple endoscopic therapies, including epinephrine injection and EBL, this patient experienced recurrent bleeding, highlighting the refractory nature of some rectal ulcers and the limited durability of conventional treatments in high-risk populations. Endoscopic band ligation has emerged as a viable adjunctive therapy in non-variceal rectal bleeding, particularly when conventional measures fail. In conclusion, early consideration of advanced endoscopic options may improve outcomes in challenging cases of rectal bleeding.