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By focusing on elderly, high-risk patients, we highlight the diagnostic complexities and management strategies associated with these routine yet potentially catastrophic anorectal procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed three cases of high-risk elderly patients who experienced acute, massive hemorrhage following routine anorectal procedures, specifically glycerin enemas and anorectal manometry. To contextualize these findings, we performed a narrative literature review of the PubMed and Web of Science databases to identify recurring clinical characteristics and predisposing factors associated with these iatrogenic rectal injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All three elderly patients with significant comorbidities experienced sudden, painless, massive hematochezia following routine anorectal procedures. Standard anoscopy failed to localize the bleeding source due to obscuration by extensive blood clots. However, emergency colonoscopy without bowel preparation successfully identified and treated bleeding foci in the distal rectum (3\u20134\u00a0cm from the anal verge). Clinically, the patients demonstrated profound hemoglobin drops ranging from 10 to 80\u00a0g\/L (nadir: 59\u00a0g\/L) and severe hemodynamic instability (lowest blood pressure [BP]: 89\/56 mmHg; Heart rate[HR]: 120\u00a0bpm). Two patients required massive blood transfusions, receiving up to 13 units of red blood cells and 1,350 mL of fresh frozen plasma to maintain stability. Notably, all three patients required Intensive care unit (ICU) admission for intensive monitoring and resuscitation. Common risk factors identified included advanced age, prolonged bed rest, and underlying coagulopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2014it is life-saving and should be formally integrated into clinical guidelines to enhance safety for high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04769-7","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T11:16:34Z","timestamp":1774696594000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Life-threatening lower gastrointestinal bleeding after routine anorectal procedures: a case series and management implications"],"prefix":"10.1186","volume":"26","author":[{"given":"Xiangyi","family":"Yin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"issue":"28","key":"4769_CR1","doi-asserted-by":"publisher","first-page":"4466","DOI":"10.3748\/wjg.v29.i28.4466","volume":"29","author":"M Obeidat","year":"2023","unstructured":"Obeidat M, Teutsch B, Rancz A, Tari E, M\u00e1rta K, Veres DS, Hossz\u00fafalusi N, Mih\u00e1ly E, Hegyi P, Er\u0151ss B. 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According to the policy of our institutional review board, ethical approval was waived for this retrospective case series. Written informed consent was obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from all patients for publication of this case series and accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"279"}}