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

Abstract

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.

Endoscopic Management of Rectal Dieulafoy's Lesion: A Case Series and Optimal Treatment

“…In our reported cases, there were equal numbers of males and females, and all patients were over 65 years old (Table 1). Patients with DL are usually divided into young and old groups 6. Significant comorbidities, including diabetes, hypertension, CKD, cardiovascular disease, and excessive consumption of alcohol are usually observed in the older patient group.…”

“…Several recent reports have demonstrated the efficacy of EBL and EHP for DL in the upper gastrointestinal tract 9,10,11. There are several case reports of the successful treatment of rectal DL by EBL or EHP 3,4,6,12,13,14,15. However, opinions concerning EBL and EHP are conflicted.…”

Elderly case of Dieulafoy's lesion in the jejunum presenting with repeated hemorrhagic shocks

“…Aging may be a risk factor for DL 4 . The findings of DL in elderly patients suggest that atherosclerosis is associated with DL 4 .…”

“…Dieulafoy's lesion is a vascular malformation and a rare but potentially life‐threatening disease 1–4 that is responsible for 7% of upper gastrointestinal hemorrhage 3 . DL in the small intestine is extremely rare, and the diagnosis is difficult 1–3 .…”

“…The findings of DL in elderly patients suggest that atherosclerosis is associated with DL 4 . DL also may be caused by an aneurysm in one of the vessels, perhaps in combination with atherosclerosis 4 . Meanwhile, congenital or acquired vascular malformation might be an underlying cause in young patients 1,4 …”