A case of rectal Dieulafoy’s lesion successfully treated by transcatheter arterial embolization

Abstract

A 50-year-old man showed massive lower gastrointestinal bleeding without a triggering episode. An emergency colonoscopy revealed a protruding vessel in the lower rectum with no active bleeding. No underlying ulcer was seen within the surrounding mucosa. These findings were consistent with rectal Dieulafoy's lesion. Angiography was requested to identify the source of bleeding and for possible embolization. On the initial angiography, the bleeding point was unclear. Abnormal vessels such as arteriovenous malformation or nidus were not found. He again developed hematochezia, requiring transfusion of red blood cells. However, the second colonoscopy showed no active bleeding from the protruding vessel in the rectum. During the second angiography, sudden bleeding occurred. Angiography showed extravasation of contrast medium from the distal branch of the superior rectal artery. Transcatheter arterial embolization was performed, and was very effective.

A case of the lower gastrointestinal bleeding due to Dieulafoy’s ulcer in the cecum

“…Angiography is a useful therapy when endoscopy fails. However, the disadvantage of an angiographic approach is the lack of intraoperative direct view and the difficulty of determining the embolization site when bleeding has stopped [16]. Surgery is also a useful therapy when endoscopy and angiography fail, but today these surgical approaches have been replaced by endoscopic and angiographic techniques in most cases.…”

“…We, thus, consider endoscopic treatment as the current treatment of choice. Endoscopic treatment is performed by injection of sclerosants such as hypertonic saline epinephrine, pure ethanol, hypertonic glucose, cyanoacrylate and thermic mechanisms such as argon plasma coagulation and heater probe coagulation, mechanical hemostasis with endoscopic clips or band ligation, or even a combination of different hemostatic methods [ 16 – 19 ]. Methods of mechanical hemostasis such as endoscopic clips or band ligation are reportedly better than injection of sclerosants in terms of the number of treatments and the effects of rebleeding suppression [ 20 – 22 ].…”

Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

“…In our review, angiographic embolization was performed in four cases. Two patients were successfully treated with this modality while the other two required surgery for definitive hemostasis (57,(90)(91)(92).…”

Hemorragia digestiva baja masiva por lesión de Dieulafoy rectal

“…Se caracteriza por la existencia de una arteria submucosa anormalmente dilatada (1-3 mm), generalmente con un calibre 10-20 veces superior al de un capilar normal, que erosiona la mucosa suprayacente, dando lugar a sangrado gastrointestinal sin evidencia de úlcera primaria o aneurisma 1,2 . Esta malformación puede alojarse en cualquier parte del tracto gastrointestinal, siendo la más frecuente el estómago (72 %), seguido de duodeno (15 %), esófago (8 %), colon (2 %), recto (2 %) y yeyuno-íleon (1 %) [3][4][5] . Afecta generalmente a varones en la quinta década de la vida y se presenta como hematemesis repentina masiva, recurrente e indolora, pero también puede manifestarse en forma de melenas, hematoquecia e hipotensión.…”