Rectal ulceration caused by the anti-anginal nicorandil: Case report of a preventable complication

The association of the anti-anginal drug nicorandil with oral and anal ulceration is becoming more widely recognised, but there are no reports of isolated nicorandil-induced rectal ulceration. Awareness of this condition is poor, and patients often undergo unnecessary surgery for a condition which resolves on stopping the medication. We report a case of nicorandil-induced rectal ulceration causing rectal bleeding. The patient was spared surgery after awareness of the link with this drug. This diagnosis should be considered in patients with unexplained gastrointestinal ulceration after exclusion of serious underlying causes. We hope this report will increase awareness amongst physicians and surgeons of this reversible condition.