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Rectal Bleeding from a Mucous Fistula Secondary to a Dieulafoy's Lesion

Abdelmalek, Manal F. M.D.; Pockaj, Barbara A. M.D.; Leighton, Jonathan A. M.D.

Journal of Clinical Gastroenterology: June 1997 - Volume 24 - Issue 4 - p 259-261
Case Studies

Dieulafoy's lesion is a submucosal artery associated with a minute mucosal defect, and it is an extremely rare cause of profuse but intermittent gastrointestinal bleeding. Most cases have occurred in the proximal stomach within 6 cm of the gastroesophageal junction. Less commonly, cases are encountered in the antrum, duodenum, jejunum, colon, and rarely the rectum. Only three cases of rectal Dieulafoy's lesion have been reported in the English medical literature: one in a child and two in otherwise healthy young men. We report a case of a rectal Dieulafoy's lesion in an elderly man with a mucous fistula. Successful treatment was administered with a combination of injection therapy and heater-probe coagulation followed by elective surgical oversewing. Rectal Dieulafoy's lesions should be included in the differential diagnosis of unexplained rectal bleeding in the elderly.

From the Department of Gastroenterology and General Surgery, Mayo Clinic, Scottsdale, Arizona, U.S.A.

Received November 20, 1996. Sent for revision November 26, 1996. Accepted January 21, 1997.

Address correspondence and reprint requests to Dr. Jonathan A. Leighton, Department of Gastroenterology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, AZ 85259, U.S.A.

Editor's Note: Dieulafoy's lesion of the stomach is now well known, but recently two reports of a similar lesion in the rectosigmoid arrived in this office, the first from Nagasaki and the second from one of the Mayo clinics.

Although neither case has histologic proof, the endoscopic criteria seem convincing even to a nonendoscopist. The pictures are characteristic, and just as two swallows tell us that summer is on the way, these reports suggest to me that other cases will quickly be reported. What later was called "Dieulafoy's" lesion in the stomach was first called "gastric apoplexy" because of the small exposed blood vessels spurting blood. In any event, I am convinced. Are the readers?-H.M.S.

© Lippincott-Raven Publishers