Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report

Abstract

BACKGROUND Rectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage. CASE SUMMARY A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up. CONCLUSION Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.

Endoscopic Ultrasound-Guided Coil Embolization of Refractory Rectal Dieulafoy Bleeding

“…2 Various endotherapy modalities were reported in the literature with a primary hemostasis success up to 87%. 1,[3][4][5] We report a case of recurrent rectal Dieulafoy bleeding despite multiple conventional endoscopic treatments, which subsequently responded to endoscopic ultrasound (EUS)-guided coil embolization of the feeding arteriole.…”

Severe lower gastrointestinal bleeding caused by rectal Dieulafoy’s lesion: Case reports and literature review

“…However, these patients frequently experience serious complications and are at high risk for surgery or respiratory or circulatory failure, and cannot be transferred to the intervention room. [9] Bedside colonoscopy is currently considered the first option for the management of gastrointestinal Dieulafoy’s lesions. [9] Although the effectiveness of different emergent endoscopic treatments, including injection, coagulation, clipping, and band ligation, in the management of rectal Dieulafoy’s lesions has been demonstrated, [8] there is no consensus on the optimal endoscopic hemostasis technique for rectal Dieulafoy’s lesions owing to the rarity of the disease.…”

“…[9] Bedside colonoscopy is currently considered the first option for the management of gastrointestinal Dieulafoy's lesions. [9] Although the effectiveness of different emergent endoscopic treatments, including injection, coagulation, clipping, and band ligation, in the management of rectal Dieulafoy's lesions has been demonstrated, [8] there is no consensus on the optimal endoscopic hemostasis technique for rectal Dieulafoy's lesions owing to the rarity of the disease. We report 2 cases of acute hemorrhage due to rectal Dieulafoy's lesion that were both successfully treated by endoscopic hemostatic clipping.…”