When everything seemed over... the rectal bleeding begins: about a rare post-prostate biopsy incident

Prostate biopsy is a common and minimally invasive diagnostic procedure that can be easily performed in outpatient settings. Early rectal or urinary bleeding, usually mild and self-limiting, has been well documented. We report here the case of a 65-year-old patient who presented with moderately heavy rectal bleeding nine days after a transrectal prostate biopsy performed under anticoagulant therapy for an elevated PSA level. Endoscopic examination revealed a congested and erythematous area of the posterior rectal wall corresponding to the biopsy puncture site, associated with internal hemorrhoids, without active bleeding. The bleeding resolved spontaneously under conservative management, without endoscopic or radiological intervention. This case illustrates an exceptional delayed hemorrhagic complication following prostate biopsy, highlighting the importance of close post-procedural monitoring and individualized anticoagulant management.