Life-threatening lower gastrointestinal bleeding after routine anorectal procedures: a case series and management implications

In frail, bedridden patients, even routine anorectal procedures such as enema administration or catheterization can trigger catastrophic, life-threatening hemorrhage. While instrumentation is the primary trigger, clinical outcomes depend on recognizing potential mucosal vulnerability. The key to survival lies in early risk stratification, maintaining a high index of clinical suspicion regarding recent procedural history, and proceeding directly to emergency colonoscopy to identify and treat hidden bleeding sources in the distal rectum. Such vigilance is not merely best practice-it is life-saving and should be formally integrated into clinical guidelines to enhance safety for high-risk populations.