American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Apply for this position
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American Journal of Medical Case Reports. 2017, 5(10), 259-261
DOI: 10.12691/ajmcr-5-10-2
Open AccessCase Report

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

Nazish Malik1, , Munawwar Hussain1 and Syed Mussadiq Ali Akbar Naqvi2

1Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown PA, USA

2Department of Internal Medicine, Parkland Hospital Dallas, TX, USA

Pub. Date: October 23, 2017

Cite this paper:
Nazish Malik, Munawwar Hussain and Syed Mussadiq Ali Akbar Naqvi. An unusual Presentation of Dieulafoy’s Lesion as a Cause of Recurrent Lower Gastrointestinal/Rectal Bleeding: A Case Report. American Journal of Medical Case Reports. 2017; 5(10):259-261. doi: 10.12691/ajmcr-5-10-2

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.

Keywords:
Dieulafoy’s lesion recurrent bleeding internal hemorrhoids diagnostic approaches

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References:

[1]  Baxter, M., & Aly, E. (2010). Dieulafoy’s lesion: current trends in diagnosis and management. Annals of The Royal College of Surgeons of England, 92(7), 548-554.
 
[2]  Ibrarullah, M., & Wagholikar, G. D. (2003). Dieulafoy’s lesion of duodenum: a case report. BMC Gastroenterology, 3, 2.
 
[3]  Apiratpracha, W., Ho, J. K., Powell, J. J., & Yoshida, E. M. (2006). Acute lower gastrointestinal bleeding from a dieulafoy lesion proximal to the anorectal junction post-orthotopic liver transplant. World Journal of Gastroenterology: WJG12(46), 7547-7548.
 
[4]  Nojkov, B., & Cappell, M. S. (2015). Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy. World Journal of Gastrointestinal Endoscopy, 7(4), 295-307.
 
[5]  Cui, J., Huang, L.-Y., Liu, Y.-X., Song, B., Yi, L.-Z., Xu, N., … Wu, C.-R. (2011). Efficacy of endoscopic therapy for gastrointestinal bleeding from Dieulafoy’s lesion. World Journal of Gastroenterology: WJG, 17(10), 1368-1372.