Pineda-De Paz MR, Rosario-Morel MM, Lopez-Fuentes JG, Waller-Gonzalez LA, Soto-Solis R. Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report. World J Gastrointest Endosc 2019; 11(7): 438-442 [PMID: 31367269 DOI: 10.4253/wjge.v11.i7.438]
Corresponding Author of This Article
Rodrigo Soto-Solis, MD, MHA, Adjunct Professor, Department of Endoscopy, National Medical Center November 20TH, ISSSTE, 540 Felix Cuevas Avenue, Del Valle, Benito Juarez, Mexico City 03229, Mexico. rodrigosotomd@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2019; 11(7): 438-442 Published online Jul 16, 2019. doi: 10.4253/wjge.v11.i7.438
Endoscopic management of massive rectal bleeding from a Dieulafoy's lesion: Case report
Mario Rene Pineda-De Paz, Massiel Madelin Rosario-Morel, Jose Guadalupe Lopez-Fuentes, Luis Ariel Waller-Gonzalez, Rodrigo Soto-Solis
Mario Rene Pineda-De Paz, Massiel Madelin Rosario-Morel, Jose Guadalupe Lopez-Fuentes, Luis Ariel Waller-Gonzalez, Rodrigo Soto-Solis, Department of Endoscopy, National Medical Center November 20TH, ISSSTE, Mexico City 03229, Mexico
Author contributions: Pineda-De Paz MR, Rosario-Morel MM, Lopez-Fuentes JG and Soto-Solis R contributed to concept and design, literature review, and drafting of the manuscript; Pineda-De Paz MR acquired the data and figures; Pineda-De Paz MR, Rosario-Morel MM, Waller-González LA, and Soto-Solis R revised the manuscript for important intellectual content; all authors had access and approved the last version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for endoscopic procedures and for the publication of this report.
Conflict-of-interest statement: Authors declare no conflict of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rodrigo Soto-Solis, MD, MHA, Adjunct Professor, Department of Endoscopy, National Medical Center November 20TH, ISSSTE, 540 Felix Cuevas Avenue, Del Valle, Benito Juarez, Mexico City 03229, Mexico. rodrigosotomd@hotmail.com
Telephone: +52-551-9591008 Fax: +52-555-7661699
Received: May 10, 2019 Peer-review started: May 14, 2019 First decision: May 31, 2019 Revised: June 5, 2019 Accepted: June 20, 2019 Article in press: June 21, 2019 Published online: July 16, 2019 Processing time: 69 Days and 8.2 Hours
Abstract
BACKGROUND
Rectal Dieulafoy's lesions (DLs) are very rare; however, they can be life threatening when presented with massive hemorrhage.
CASE SUMMARY
A 44-year-old female with medical history of chronic renal failure who was on renal replacement therapy presented with lower gastrointestinal hemorrhage. Physical examination revealed signs of hypovolemic shock and massive rectal bleeding. Complete blood count revealed abrupt decrease in hematocrit. After hemodynamic stabilization, an urgent colonoscopy was performed. A rectal DL was diagnosed, and it was successfully treated with two hemoclips. There were no signs of recurrent bleeding at thirty days of follow-up.
CONCLUSION
Rectal DLs represent an unusual cause of lower gastrointestinal bleeding. Massive hemorrhage can increase the morbidity and mortality of these patients. Endoscopic management continues to be the reference standard in the diagnosis and therapy of these lesions. Thermal, mechanical (hemoclip or band ligation), or combination therapy (adrenaline injection combined with thermal or mechanical therapy) should be considered the first choice for treatment.
Core tip: Rectal Dieulafoy's lesion (DL) represents an unusual cause of lower gastrointestinal bleeding. A 44-year-old female with medical history of chronic renal failure presented massive rectal bleeding. After proper initial management, an urgent colonoscopy was performed. A rectal DL was diagnosed and successfully treated with two hemoclips without recurrence of hemorrhage. Endoscopy is the reference standard for the diagnosis and treatment of these lesions.
