An unusual Presentation of Dieulafoy’s Lesion as a Cause of Recurrent Lower Gastrointestinal/Rectal Bleeding: A Case Report

Abstract

Background: Dieulafoy lesion is a rare cause of acute gastrointestinal bleeding. It can present with sudden and massive bleeding without any prior symptoms. It causes massive hemorrhage leading to hemodynamic instability and this complicated nature of disease puts emphasis on its immediate diagnosis and treatment. Most commonly it presents with upper GIT bleeding but it can present with lower gastrointestinal bleeding. Case Presentation: We report a case of recurrent lower gastrointestinal bleeding that was miss diagnosed initially as internal hemorrhoids. A 91-year-old male was discharged 2 weeks ago, who presented again with rectal bleeding and low hemoglobin found on lab reports. He was admitted and transfused two packs of PRBC. After not finding any visible bleeding on upper endoscopy, he had colonoscopy and a bleeding vessel was found in rectum. Clipping was performed to stop bleeding and he was discharged home. Lower gastrointestinal bleeding is a very rare presentation of dieulafoy lesion. Conclusion: Dieulafoy lesion can present with upper or lower gastrointestinal bleeding. Diagnostic improvements and research for the detection of DL needs to be conducted to reduce hospital stay and improve survival. Endoscopic measures, mechanical banding, hemoclipping and electrocoagulation are some of the frequently used treatment options.

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

“…As expected, the administration of these medications potentially increases the risk for prolonged and severe gastrointestinal hemorrhage. In patients with rectal Dieulafoy's lesion, hypertension (29%), diabetes mellitus (21%), chronic renal disease (16%), cancer (14%), ischemic heart disease (11%), and prior cerebrovascular accident (11%) were among the common comorbid conditions (47)(48)(49)(50).…”