Lower GI Bleed due to Dieulafoy Lesion in Ascending Colon with Histopathological Confirmation

Abstract

Figure: No Caption available.Purpose: Dieulafoy disease is a rare cause of upper gastrointestinal bleeding and even rarer for colonic bleed. The dieulafoy lesion of the colon was first described by Barbier in 1985.We present a patient who had multiple dieulafoy lesions in the ascending colon, underwent endoscopic therapy and finally surgical resection with histopathologic confirmation of the dieulafoy lesion underneath endoscopically applied hemoclips. Patient is a 71-year-old male with past medical history of coronary artery disease, stroke, and pulmonary embolism on Coumadin presented with symptomatic anemia due to lower GI bleed in December 2011. His Hb was 9 with normal MCV. At that time he was found to have a Dieulafoy lesion of the ascending colon and underwent endoscopic ablation with endoscopic hemoclip placement. He presented with recurrent lower GI bleeding three times in next 8 months needing colonoscopy each visit and underwent endoscopic placement of hemoclips and epinephrine injection of dieulafoy lesions with successful hemostasis. Videos and still images of the bleeding lesion were obtained as well as images of endoscopic metallic clip placement and injection therapy. Due to his history of pulmonary embolism requiring anticoagulation therapy, coronary artery disease and need for multiple blood transfusions of each episodes of GI bleeding, surgical consultation for colonic resection was obtained. Following resection of the ascending colon, the pathologist was able to perform cuts on gross specimen between the two endoclips applied during his last endoscopy and histopathologic evaluation confirmed the presence of a colonic Dieulafoy lesion. The patient has remained clinically stable without the further signs of GI bleeding since his colon resection. Colonic Dieulafoy lesions are uncommon source for gi bleeding but confirmation with histopathologic proof of the clinical impression is exceedingly rare.