Dieulafoy lesion in the colon: a rare cause of lower gastrointestinal bleeding

Dieulafoy lesion is an uncommon cause of gastrointestinal bleeding [1] [2]. It is most often located in the proximal portions of the gastrointestinal tract, but unusual locations such as the colon have also been reported. It is defined by a large and tortuous submucosal arteriole that protrudes through the mucosal layer and may be a cause of massive and recurrent bleeding [3] [4]. The clinical presentation is variable and consists of hematemesis, melena, hematochezia, enterorrhagia, or anemia of unknown cause [4]. Common endoscopic findings are the presence of a superficial protruding vessel in a small mucosal defect (with or without active bleeding) and the presence of fresh clot adherent to a tiny defect in the normal gastrointestinal mucosa [3] [4].

Endoscopic treatment is the method of choice, and success rates are above 90 %. Surgery may be required for severe and refractory bleeding and after failure of endoscopic therapy (which occurs in 5 % of cases) [2] [3] [4].

A 79-year-old woman diagnosed with bone metastatic breast cancer was admitted with complaints of asthenia, lack of appetite, and intermittent lower gastrointestinal bleeding. At admission, her hemoglobin level was 7.3 g/dL. After initial resuscitative measures, upper digestive endoscopy was performed and revealed no significant findings. During colonoscopy, active bleeding from a small vessel (Dieulafoy lesion) in the ascending colon was observed ([Fig. 1]). Endoscopic therapy with three through-the-scope hemoclips was successfully carried out ([Video 1]). An endoscopic tattoo with nanquim ink was performed at the bleeding site in case of recurrence or a need for surgical intervention ([Fig. 2]). The patient was discharged after 6 days with normal hemoglobin levels and no signs of rebleeding.

Fig. 1 Active bleeding from a Dieulafoy lesion in the colon of a 79-year-old woman: underwater view.

Video 1 Endoscopic diagnosis and treatment of a Dieulafoy lesion in the colon.

Fig. 2 Final endoscopic appearance after endoscopic tattooing.

Endoscopy_UCTN_Code_CCL_1AD_2AF

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Christopher MC, Hundal R, Cheng EJ. Colonic Dieulafoy’s lesion: a rare cause of lower gastrointestinal hemorrhage and review of endoscopic management. Case Reports in Gastrointestinal Medicine 2014; 1: 1-5
• 2 Baxter M, Aly EH. Dieulafoy’s lesion: current trends in diagnosis and management. Ann R Coll Surg Engl 2010; 92: 548-554
• 3 Fukita Y. Treatment of a colonic Dieulafoy lesion with endoscopic hemoclipping. BMJ Case Rep 2013; 1: 1-2
• 4 García AZG, Blanco AP, Pérez DN. et al. Management of colonic Dieulafoy lesions with endoscopic mechanical techniques: report of two cases. Dis Colon Rectum 2004; 47: 1539-1543

Publication History

Article published online:
08 October 2020