Introduction:
Lower gastrointestinal bleeding (LGIB) is a significant clinical
concern, accounting for about 30% of major gastrointestinal bleeding
episodes requiring hospitalization. While upper gastrointestinal sources
are more common, lower GI bleeding presents a diverse array of potential
etiologies, ranging from diverticulosis and angioectasias to ischemic
colitis, neoplasms, and hemorrhoids [1].
Dieulafoy lesions represent a unique vascular anomaly within the GI
tract, characterized by an abnormally large submucosal artery that
erodes the overlying mucosa without an associated ulcer or erosion,
potentially leading to significant bleeding [2]. Dieulafoy lesions
stand out as a rare but noteworthy cause of LGIB, constituting about 2%
of acute GI bleeds [3]. These lesions are more commonly associated
with the upper GI tract, typically in the stomach near the
gastroesophageal junction, due to the vascular supply from the left
gastric artery branches. However, they can occur throughout the GI
tract, including the colon, though this presentation is rare [2,4].
The pathogenesis of Dieulafoy lesions is not completely understood, but
arterial wall necrosis leading to rupture has been suggested.
Additionally, risk factors such as NSAIDs, tobacco, alcohol use, and
peptic ulcer disease may exacerbate the potential for bleeding from
these lesions [2]. The diagnosis is typically made endoscopically,
with criteria including the presence of a protruding vessel or active
bleeding from a small mucosal defect surrounded by normal tissue
[2].
Endoscopic intervention remains the cornerstone of treatment, with
mechanical modalities like band ligation and hemostatic clips being
highly effective. Combination therapy has been shown to be superior to
monotherapy in achieving hemostasis, which is successful in
approximately 80-85% of cases [2].
The case we present emphasizes the importance of considering Dieulafoy
lesions in the differential diagnosis of LGIB, given their potential for
significant blood loss and the effectiveness of prompt endoscopic
intervention in resolving bleeding and stabilizing patients.