Severe lower gastrointestinal bleeding caused by rectal Dieulafoy's lesion: Case reports and literature review

Abstract

Rationale: Dieulafoy's lesion are relatively rare and can cause severe gastrointestinal bleeding. A Dieulafoy's lesion is defined as an artery that erodes the overlying epithelium without the presence of an ulcer. Bleeding in Dieulafoy's lesion predominantly involves the proximal stomach and upper gastrointestinal tract and is rarely observed in the lower gastrointestinal tract.

Patient concerns: Case 1 was a 58-year-old woman complaining of sudden headache and vomiting who was diagnosed with subarachnoid hemorrhage. She underwent transcatheter embolization for intracranial aneurysm treatment but had an acute profuse hematochezia on the 11th day of admission. Case 2 was a 63-year-old man admitted to the respiratory intensive care unit because of fever with altered consciousness level for a week. He was diagnosed with advanced lung cancer that had metastasized to multiple organs one month prior. On the third day of admission, he had an attack of profuse hematochezia, and quickly developed shock and apathy.

Diagnosis: Both patients were diagnosed with actively bleeding rectal Dieulafoy's lesion by bedside emergency colonoscopy.

Interventions: Endoscopic hemostatic clipping was performed in 2 patients.

Outcomes: Hemostasis was successfully achieved in these 2 patients, and there was no recurrence of symptoms during follow-up.

Conclusions: We propose that hemostatic clipping is one of the options in the treatment of rectal Dieulafoy's lesions.