S2139 A Pain in the Butt! A Rare Case of Perianal Dieulafoy's Lesion

Abstract

INTRODUCTION: Dieulafoy's lesion was first reported by Gallard in 1884; however, more appropriately described 14 years later by a French surgeon, Georges Dieulafoy. Dielafoy’s lesions are defined as high-caliber arteries that erode the overlying GI mucosa. The caliber for these arteries is approximately 10x larger than the normal caliber of submucosal vessels. Currently, in literature 70% of lesions occur within the stomach, other common locations include duodenum, distal stomach, esophagus, and in the small intestine. Dieulafoy's lesion within the rectum has been very rarely described in the literature. CASE DESCRIPTION/METHODS: We present the case of an 88-year-old male with benign prostatic hyperplasia and hemorrhoids arriving at the emergency department with a chief complaint of rectal bleeding. The patient stated experienced heavy blood per rectum and tenesmus the morning of coming to the emergency department. Within the emergency department, the patient continuously had blood clots around his anus seen as well as flowing from his rectum. His last colonoscopy was more than 15 years prior. On physical examination: Vitals were within normal limits. The patient's physical examination was benign as well. In terms of his labs, they were mainly remarkable for hemoglobin of 7.2. The patient underwent a CT abdomen pelvis with contrast which showed no cause of reported rectal bleeding identified. He then underwent a bleeding scan which showed no scintigraphic evidence of active GI bleeding. Gastroenterology was consulted and he recommended the patient undergo a colonoscopy. Colonoscopy revealed an dieulafoy lesion with a perianal area with fresh bleeding. During the colonoscopy dieulafoy's lesion was treated successfully with epinephrine and cauterization. The patient did not experience any bleeding following the intervention and was discharged home with outpatient follow-up. DISCUSSION: Dieulafoy's lesion is a rare cause of gastrointestinal bleeding, occurring up to 6% of cases of non-varicose bleeding in the upper GI tract and in 1–2% of all gastrointestinal hemorrhages. However, the prevalence of Dieulafoy's lesion within the anal canal has not yet been described in literature due to its rarity. We have concluded in our case that Dieulafoy's lesion should be an important consideration when tackling patients with lower gastrointestinal bleeding.Figure 1Figure 2