The classic Dieulafoy lesion is a minute gastric mucosal defect which bleeds massively
from an exposed artery. Although, only five cases of rectal Dieulafoy lesions have
been reported, the methods of controlling the bleeding have differed from case to
case [1]
[2]
[3]
[4]
[5]. We report a case of rectal Dieulafoy lesion in which the bleeding was controlled
by endoscopic clipping.
An 82-year-old man underwent operation for an internal hemorrhoid using the Milligan-Morgan
method. On POD 18, there was a sudden incidence of hematochezia with bright red blood.
The bleeding was not from the surgical wound. The patient's blood pressure fell from
130/70 mmHg to 70/50 mmHg, and the hemoglobin level dropped from 13.1 mg/dl to 8.6
mg/dl. Urgent colonoscopy was performed. Washing the clot revealed a small mucosal
punched-out lesion in the rectum, 7 cm proximal to the anal verge, containing an exposed
vessel oozing blood (Figure [1] a). There were no ulcers or erosions around the lesion. The lesion was closed with
two endoscopic clips (Figure [1] b). There was no further bleeding and follow-up colonoscopy 4 days later showed that
the lesion had healed well.
Figure 1 a A Small punchend-out lesion is seen in rectal mucosa, 7 cm from anal verge. A small
red spot and oozing of blood are visible in the lesion; and the spot was believed
to be a vessel. b The small punched-out lesion is closed using two clips
An endoscopic diagnosis of rectal Dieulafoy lesions is not always easy, because the
lesions are very small, and there are usually clots or stools in the rectum. It is
important that endoscopists keep the diagnosis in mind and examine the rectum after
washing it well.
Three of the five reported cases were treated by sclerotherapy under endoscopic guidance
[2]
[3]
[5]. The other two cases were treated by direct oversewing [1]
[4]. In our patient, the lesion was clipped under endoscopic vision. We recommend this
method of treatment even when the exposed vessel protrudes from the mucosa, because
we have successfully used this procedure to treat gastric Dieulafoy lesions. We recommend
this safe and useful procedure for this disease.
