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.
Highlights
Dieulafoy lesion is a rare cause of acute gastrointestinal bleeding
He was diagnosed with internal hemorrhoids when he presented with lower GI bleed
More cases are diagnosed on first endoscopy, in some cases it remains undiagnosed till repeat endoscopy or until angiography is done
Summary
A 91-year-old male patient presented with fresh bleeding per rectum, weakness and low hemoglobin as lab finding Two weeks ago, he was diagnosed with internal hemorrhoids when he presented with lower GI bleed. He was diagnosed with internal hemorrhoids when he presented with lower GI bleed He had EGD done on that admission which reported superficial non-bleeding gastric ulcers. He presented again with bleeding per rectum and abnormal labs He had history of peptic ulcer disease, HTN, CKD stage 5, atrial fibrillation, chronic diastolic congestive heart failure and sick sinus syndrome status post pacemaker. He had no allergies, no significant family history, and a life time nonsmoker.
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