Abstract

Total colonoscopy was performed on an 89-year-old man who was not treated with anticoagulation therapy. He had developed purpura in the rectum below the peritoneal reflection by the aspiration for endoscopic mucosal resection to rectal polyp. The purpura resulted in spontaneous cessation, but he had lower abdominal pain thereafter. He was diagnosed to have intramural hematoma of the rectum from rectosigmoid to above the peritoneal reflection by computed tomography and sigmoidoscopy. It disappeared with conservative therapy. We infer that it was secondary rectal intramural hematoma triggered by excessive straining against purpura.

Keywords: Rectum; Intramural hematoma; Endoscopic mucosal resection; Abdominal pain; Straining

Abbreviations: IH: Intramural Hematoma; TCS: Total Colonoscopy; RB: Rectum below the peritoneal reflection EMR: Endoscopic Mucosal Resection, PT-INR: Prothrombin Time-International Normalized Ratio; APTT: Activated Partial Thromboplastin Time; CT: Computed Tomography; RS: Rectum from Rectosigmoid RA: Rectum above the Peritoneal Reflection