Management of Colonic Dieulafoy Lesions With Endoscopic Mechanical Techniques: Report of Two Cases

Abstract

Although Dieulafoy lesion is generally located in the proximal stomach, other locations have been reported. We present two cases of bleeding colonic Dieulafoy in patients with chronic renal failure who were treated with mechanical methods. In the first case, an active arterial bleeding without mucosal defect was localized in the descending colon. In the second case, a protruding vessel with active bleeding was found in the transverse colon. The two patients were initially treated with epinephrine and hemostatic clips. In the second patient, an endoloop was attached to the base of the previously placed hemoclips because of rebleeding. To our knowledge, this is the first case of combined endoscopic approach with hemostatic clips and endoloop to treat a colonic Dieulafoy lesion. Colonic Dieulafoy lesions reported in the relevant literature and the hemostatic treatments used are reviewed.

Massive bleeding from a rectal Dieulafoy lesion in a patient with alcoholic cirrhosis

“…Most cases of rectal Dieulafoy lesions have been reported in patients with multiple comorbidities like advanced age [4][5][6], renal failure [7], burns [8], and liver transplantation [9]. In Korea, one case was reported for alcoholic cirrhosis [10].…”

“…We were able to control the bleeding successfully using hemoclips and no bleeding occurred thereafter. Endoscopic treatment is currently considered the first option for management of GI Dieulafoy lesions [7]. Although rare, a rectal Dieulafoy lesion should be included in the differential diagnosis of massive GI bleeding in a patient with cirrhosis.…”

“…Although it can occur in any part of the GI tract, the stomach is the most common location, accounting for approximately 71% of cases and it is very rare in the rectum [4]. Bleeding due to a rectal Dieulafoy lesion has been reported sporadically in many medical conditions including one case of alcoholic cirrhosis in Korea [4][5][6][7][8][9][10].…”

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

“…Unlike gastric Dieulafoy's lesions, however, thermal coagulation of colorectal lesions, especially those with recurrent bleeding after initial endoscopic coagulation, may be associated with a greater risk of perforation because of the relative thinness of the colorectal wall compared with the stomach. Therefore, a mechanical method of therapy that minimizes tissue injury, such as hemoclip application and band ligation, may be a better choice for management of bleeding from a Dieulafoy's lesion [10].…”

Ulcus Dieulafoy des Rektums

“…In 10% der extragastralen Lokalisationen findet sich die Läsion im Kolorektum [7] und hier wiederum mit 42% der kolorektalen Fälle am häufigs-ten im Rektum [10]. Eine Übersicht über bisher 31 in der Literatur existierende klinische Fallbeschreibungen eines Ulcus Dieulafoy im Rektum gibt Tabelle 1.…”