Objective: Immediate or delayed rectal bleeding following transrectal needle biopsy of the prostate has a reported incidence of 0% to 37%, and some cases can require emergency intervention. We describe a new method of treatment in these patients: colonoscopic hemoclip placement.
Methods and Results: A 79-year-old man with elevated prostate specific antigen level underwent transrectal needle prostatic biopsy with an 18-gauge needle. Several hours after the procedure, the patient sought medical attention for rectal bleeding, resulting in a 10-point drop in hematocrit. A flexible colonoscopy showed active arterial bleeding from the biopsy site in the anterior rectal wall. Endoscopic injection of 8mL epinephrine (1:10.000 dilution) was given. Bleeding continued. A clip was deployed (quick-clip) with excellent grasp of the mucosa surrounding the bleeding site. The patient did not require a blood transfusion and was discharged in stable condition after the urethral catheter was extracted.
Conclusions: When hemorrhage appears after prostate biopsy, different maneuvers can be performed: local pressure, transcatheter arterial embolization, proctoscopic thermocoagulation, colonoscopic injection of epinephrine or proctoscopic placement of a rubber band used for hemorrhoid treatment. If other maneuvers are not effective, endoscopic placement of a clip can be used as a treatment for this rare complication.
