Morphological changes of colonic Dieulafoy's lesion: a case that could be retrospectively reviewed in a patient without treatment.

Abstract

Colonic Dieulafoy's lesion (DL) is an unusual cause of lower gastrointestinal hemorrhage. We herein report the first case of DL in which the morphological changes could be retrospectively reviewed by endoscopy. A 61-year-old female, who was taking anti-thrombotics including low-dose aspirin, was admitted to our department with acute onset massive flesh bleeding per rectum. Although an emergent colonoscopy was performed, no bleeding source could be detected other than multiple diverticula in the ascending colon. A second colonoscopy after 1½ months revealed a small reddish polypoid lesion at the opposite site of the ileocecal valve, but showed no active bleeding points. After another 2weeks, she complained of rectal bleeding again. She immediately underwent a third colonoscopy that showed pulsatile bleeding from normal overlying mucosa without a mucosal defect at the same site at the opposite site of the ileocecal valve, consistent with the DL. The lesion was successfully managed by argon plasma coagulation therapy. When reviewing initial colonoscopic images retrospectively, a telangiectasia was observed at the same site. This retrospective evaluation by endoscopy showed that the shape of the DL is changeable over a short period. It has been reported that aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of diverticular bleeding. Therefore, endoscopists should pay close attention not only to diverticular bleeding, but also to the presence of DL when performing colonoscopy on patients with rectal bleeding and taking aspirin or NSAIDs.