Discrete colon ulcers as a cause of lower gastrointestinal bleeding and perforation in end-stage renal disease.

Since 1975 at our institution six cases of discrete colon ulcers have been noted in patients with end-stage renal disease. Five patients were on long-term hemodialysis, and one patient had received a cadaver kidney transplant. Four patients presented with lower gastrointestinal hemorrhage-two acute and two subacute. Two patients presented with diffuse abdominal pain and peritoneal signs. Two colon ulcers were diagnosed by colonoscopy, two were diagnosed in laparotomy, one was diagnosed by arteriography, and one ulcer was diagnosed only on pathologic examination of the resected colon. Pathologic examination disclosed idiopathic ulcers in all six cases. All patients were managed surgically. The mortality rate was 50%. Discrete colon ulcers should be considered in the differential diagnosis when the hemodialysis or kidney transplant patient presents with lower gastrointestinal bleeding or abdominal pain and peritoneal signs.