Pallavi Huma Arya1, Joseph Sebastian2, Sudhakar Mangam2 and Narasimhaiah Srinivasaiah3*
1University Hospital London, UK
2QEQM Hospital, UK
3St. Mark’s Hospital, UK
Introduction: Dieulafoy lesions of the upper gastrointestinal (UGI) tract are well known. Rectal lesions are less common. We present a case of a rectal Dieulafoy lesion causing significant rectal bleeding, managed successfully.Methods and
Results: A case note and literature review was done. An 82-year-old female was referred to the surgeons for management of rectal bleeding. She was treated by medical team for pneumonia; was intubated, ventilated, central venous access gained and on inotropes. She developed fresh per rectal bleeding with clots, leading to haemo-dynamic instability. She underwent an UGI endoscopy, followed by on-table colonoscopy with caecal intubation. Distal blood streaking of the mucosa till 30-35 cms was noted but no blood in the lumen beyond this. A 2-3 mm raised mucosal lesion- Dieulafoy lesion was noted in the rectal mucosa above the dentate line at 5 o’clock with an arterial spurter (Figure 1 and 2). This was over sewn with three 2.0 PDS sutures. This stopped the bleeding completely.Discussion: Dieulafoy lesion of rectum is an uncommon entity that needs to be considered as a cause of lower GI bleeding. It is very vital to visualise the distal rectum and anal canal for the cause of the bleed could be ano-rectal.
Rectal bleeding; Colonoscopy; Dieulafoy lesion; Diagnosis; Gastrointestinal surgery; Vascular surgery
Arya PH, Sebastian J, Mangam S, Srinivasaiah N. Dieulafoy Lesion of Rectum: an Uncommon Pathology not to be Missed. Clin Surg. 2016; 1: 1170.