Colonic Dieulafoy’s Lesion: A Rare Cause of Lower Gastrointestinal Hemorrhage and Review of Endoscopic Management

Abstract

Dieulafoy's lesions are a rare cause of gastrointestinal hemorrhage. Extragastric Dieulafoy's lesions are even more uncommon. We report the case of a 75-year-old woman who presented with gastrointestinal bleeding from a transverse colonic Dieulafoy's lesion. She presented with two episodes of melena followed by one episode of fresh blood per rectum. In addition, there was associated presyncope and anemia (hemoglobin 69 g/L) in the setting of supratherapeutic warfarin anticoagulation (INR 6.2) for nonvalvular atrial fibrillation. Esophagogastroduodenoscopy was negative for an upper GI source of bleeding but on colonoscopy an actively oozing Dieulafoy's lesion was identified in the transverse colon. Bipolar cautery and hemostatic endoclips were applied to achieve hemostasis. Clinicians should consider this rare entity as a potential cause of potentially life-threatening lower gastrointestinal bleeding and we review the endoscopic modalities effective for managing colonic Dieulafoy's lesions.

An Unusual Cause of Lower Gastrointestinal Bleeding: Cecal Dieulafoy's Lesion

“…In one case, a 75-year-old female presented with two episodes of melena followed by one episode of bright red blood per rectum. She was found to have a transverse colon Dieulafoy's lesion successfully treated with cautery and then two endoclips [4]. In another case from India, a 92-year-old male presented with multiple episodes of melena followed by one episode of blood per rectum.…”

Rectal Dieulafoy’s Lesion: A Rare Etiology of Lower Gastrointestinal Hemorrhage

“…Selective angiography is preferred in patients that failed endoscopic therapy, for lesions beyond the reach of therapeutic endoscopy, or in patients who are poor candidates for surgery [2]. In past years, surgical resection was the mainstay of treatment, particularly in cases of colonic Dieulafoy's lesions with massive GI hemorrhage [15]. In conclusion, Dieulafoy's lesions are an important cause of GI bleeding.…”

Lesión de Dieulafoy cecal: una causa inusual de rectorragia severa recurrente

“…Entre los diversos mecanismos propuestos se encontraba la sospecha de una dilatación aneurismática, sin embargo, no se ha logrado demostrar, tampoco la presencia de arterioesclerosis ni vasculitis, entre otras, ha demostrado ser causa de la lesión inicial 6,7,11 .…”

“…Se han descrito en esófago, duodeno, yeyuno, colon, recto y ano; el colon es de los sitios más infrecuentes, con un 2%, y existen 17 casos reportados hasta el año 2001. Es más frecuente en hombres a una edad media de 50-70 años 2,5,6 .…”