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Rectal bleeding by Dieulafoy-like lesion: successful endoscopic treatment.

Abstract
A 81-year old woman affected by chronic renal failure, non insulin-dependent diabetes mellitus (NIDM) and hypertension, had an severe anemia massive hematochezia. The colonoscopy could not localize the bleeding site except some blood spots in the rectum. The patient was readmitted after 1 month with hypovolemic shock by massive hematochezia and required several blood transfusions. The endoscopic examination showed an important arterial bleeding treated successfully with epinephrine and bipolar elettro-coagulation (BICAP). We suggested that the patient presented a Dieulafoy-like lesion; this is an uncommon gastrointestinal cause of bleeding due to a defect of a submucosal artery without evidence of atherosclerosis or vasculitis. Both chronic renal failure and age could be considered as predisponent factors in this patient. Hematochezia is the most important sign and is often complicated by haemorrhagic shock. The diagnosis was delayed due to the difficulty in localizing the bleeding site; moreover, the patient needed several blood transfusions. The arteriographic diagnosis associated to endoscopic treatment by epinephrine and BICAP enabled a successful therapy.
AuthorsG Casella, G Bonforte, R Corso, C A Buda, G Corti, A R Cambareri, F Magrì, V Baldini
JournalIl Giornale di chirurgia (G Chir) 2005 Nov-Dec Vol. 26 Issue 11-12 Pg. 415-8 ISSN: 0391-9005 [Print] Italy
PMID16472418 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Adrenergic Agonists
  • Epinephrine
Topics
  • Adrenergic Agonists (therapeutic use)
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Angiography
  • Blood Transfusion
  • Electrocoagulation
  • Endoscopy
  • Epinephrine (therapeutic use)
  • Female
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage (etiology, surgery, therapy)
  • Humans
  • Intestinal Mucosa (abnormalities, blood supply)
  • Rectal Diseases (diagnostic imaging, etiology, surgery, therapy)
  • Risk Factors
  • Shock, Hemorrhagic (etiology, therapy)
  • Time Factors
  • Treatment Outcome

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