Cecum Dieulafoy’s Lesion Presenting with Recurrent Lower Gastrointestinal Bleeding: Case Report

Abstract

Introduction: Gastrointestinal Dieulafoy's lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We report a case of a Cecum Dieulafoy's bleeding lesion that was managed endoscopically with a favorable outcome. Case report: Female, 70-year-old, diagnosed with type 2 diabetes, hypothyroidism, and chronic heart failure associated with rheumatic mitral stenosis, submitted to biological valve replacement in 2006 and with permanent atrial fibrillation using vitamin K antagonist anticoagulant for thrombosis prophylaxis. Her background includes a stroke in 2004 without any permanent disability. In 2016, the patient experienced voluptuous and painless lower gastrointestinal bleeding with severe acute anemia, requiring hospital admission, fluid resuscitation and blood transfusion. Urgent colonoscopy revealed a small reddish vascular malformation at the cecum with oozing active bleeding, about 3 mm in size. Initially argon plasma coagulation was performed with satisfactory and immediate hemostasis. One week later, she recurred with hematochezia. The lesion at the cecum was reassessed and it was possible to notice a large caliber vessel surrounded by a normal appearance mucosa, compatible with Dieulafoy's lesion and it was treated with an endoscopic clip placement with a good long-term response. Conclusion: Endoscopy is the method of choice for diagnosis of Dieulafoy's lesion and may provide efficient treatment with mechanical hemostasis such as endoclip placement with a high success rate.