Massive Gastrointestinal Bleeding Related to NSAID Use in a Patient with Ileorectal Anastomosis

TL;DR

A patient with a history of ileorectal anastomosis experienced gastrointestinal bleeding linked to NSAID use, highlighting the need for careful management.

Contribution

This case report documents NSAID-related bleeding distal to the duodenum in a patient with ileorectal anastomosis.

Findings

NSAID use was associated with gastrointestinal bleeding in a patient with ileorectal anastomosis.

Bright red blood per rectum in such patients should prompt NSAID cessation and further diagnostic evaluation.

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation in over 30 million individuals daily. Gastrointestinal bleeding (GIB) associated with NSAID consumption has been well documented in gastric and duodenal bleeding; however, NSAID-associated GIB distal to the duodenum lacks extensive documentation. This report highlights small bowel occult bleeding related to NSAID use in a patient with a surgical history of robotic total colectomy with ileorectal anastomosis completed 1 year prior. In the case of bright red blood per rectum with associated NSAID use, we recommend NSAID cessation followed by an individualized treatment plan, such as upper/lower endoscopy and/or angioembolization.

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