Massive Gastrointestinal Bleeding from a Dieulafoy-like Lesion of the Rectum

Hidaka, Masaaki; Maeda, Junpei; Taguchi, Hisao; Kanematsu, Takashi

doi:10.1097/00004836-199706000-00018

Cited by 16 publications

(9 citation statements)

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“…Sensitivity of endoscopy may be further limited in the setting of poor bowel preparation or obscured visual field due to high volume bleeding. As with other presentations of obscure lower gastrointestinal bleeding, CT angiography [15] and red blood cell scintigraphy have also been previously utilized for diagnosis [16]. …”

Section: Discussionmentioning

confidence: 99%

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

Hundal

Cheng

2014

Case Reports in Gastrointestinal Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Hundal

Cheng

2014

Case Reports in Gastrointestinal Medicine

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“…In recent studies, the diagnosis of Dieulafoy's ulcer has become possible based on endoscopic criteria, rather than on conventional histologic examination. Endoscopic criteria that establish the diagnosis include: (i) active arterial spurting or micropulsatile streaming from minute (< 3 mm) mucosal defects or through normal surrounding mucosa; (ii) visualization of a protruding vessel with or without active bleeding within a minute mucosal defect, or through normal appearing mucosa; and (iii) fresh densely adherent clotting with a narrow point of an attachment to a minute mucosal defect or to normal mucosa 14,15 , 23 . Diagnosis of this lesion as the source of bleeding is often difficult, especially as most cases present massive bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Eighteen cases with rectal Dieulafoy's ulcer (Table 1) have been described previously 10–21,24 . The diagnosis of Dieulafoy's ulcer may be difficult because of obscured visualization and the intermittent nature of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of Dieulafoy's ulcer may be difficult because of obscured visualization and the intermittent nature of bleeding. Prior to the development of colonoscopy, Dieulafoy's ulcer in the colorectal regions was diagnosed by angiography or surgery 10,15 . Prompt repeated evaluation of re‐bleeding by endoscopy is essential when an earlier examination fails to identify a plausible focus 15 …”

Section: Discussionmentioning

confidence: 99%

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SUCCESSFUL ENDOSCOPIC HEMOSTASIS OF RECTAL DIEULAFOY's ULCER BY CLIPPING: AGING MAY BE A FACTOR

Abe¹,

Okada²,

Akamatsu

et al. 2003

Digestive Endoscopy

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Dieulafoy's ulcer is a rare form of gastrointestinal bleeding. Although the original descriptions and early reports were of lesions in the proximal stomach, similar lesions have subsequently been reported in the esophagus, duodenum, jejunum, colon and rectum. A 55‐year‐old man was admitted to hospital for a sudden acute headache. On admission he was conscious, and had severe occipitalgia due to a subarachnoid hemorrhage demonstrated on computed tomography. On the fifteenth hospitalization day, he passed fresh blood together with stool, followed by several further episodes of massive hematochezia. Although no lesion was found by gastroduodenoscopy, colonoscopy revealed fresh blood and clots in the rectum. No obvious source of hemorrhage could be identified until careful irrigation revealed pulsatile bleeding from a protuberant vessel (2 mm in size) in the rectum 5 cm from the anal verge. The patient underwent an endoscopic hemostasis in which the pulsatile vessel was easily sutured with seven clips. The patient did not have another episode of bleeding. The finding of Dieulafoy's ulcer in the elderly‐patient group suggests that sclerotic changes to the artery may be associated with this type of rectal ulcer.

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“…Gelingt die Identifikation der Lokalisation der Blutungsquelle endoskopisch jedoch nicht, kann eine selektive Angiographie bei der Suche hilfreich sein [16,19,20]. Als weitere, sehr sensitive diagnostische Option gilt die Szintigraphie mit 99mTechnetium-markierten Erythrozyten [14], die in der Lage ist, Blutungen ab 0,1 ml/ min zu erfassen. Erfolgte die Therapie früher primär chirurgisch [21], so gilt heute die endoskopische Therapie im oberen und unteren Gastrointestinaltrakt abhängig von der Lokalisation mittels Hämoclipping, [4,7,15,23].…”

Section: Introductionunclassified