Rectal Dieulafoy Lesion Following Manual Disimpaction Successfully Treated with Hemoclip

Abstract

Purpose: Rectal Dieulafoy lesions are a rare cause of lower gastrointestinal bleed with few case reports describing the etiology and treatment of these lesions. A majority of Dieulafoy lesions are found in the stomach, but other locations including small intestine, colon, and rectum have been reported with increasing frequency. We report a case of a rectal Dieulafoy lesion secondary to trauma from recurrent disimpaction treated successfully with hemoclip. Results: A 54-year-old female with history of multiple sclerosis presented with bright red blood per rectum associated with a near syncopal event. She denied using non-steroidal anti-inflammatory medications, prior ulcer disease, or history of GI bleeding. As stated, she had a history of multiple sclerosis and required periodic self disimpaction. Upon presentation, she was noted to be hypotensive and tachycardic. Following aggressive resuscitation, her blood pressure improved, but she remained tachycardic. Her initial hemoglobin was 11.7 g/dL. During her evaluation in the emergency department, she continued to have bright red blood per rectum and a drop in hemoglobin to 10.1 g/dL. Flexible sigmoidoscopy was performed with visualization of a pulsating Dieulafoy lesion in the rectum approximately 4 cm from the dentate line. The Dieulafoy lesion was treated successfully with one hemoclip without further bleeding. She was monitored closely and placed on aggressive bowel protocol to alleviate the need for disimpaction. Her blood counts remained stable and there were no further episodes of bleeding. Upon follow up a couple months later, she was doing well with no further need for self disimpaction or recurrent bleeding.Figure: Rectal Dieulafoy lesion.Figure: Rectal Dieulafoy lesion following hemoclip placement.