Saha Bibek, Takkellapati Divya, Beckman Thomas J
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Mayo Clinic Alix School of Medicine, Rochester, MN, USA.
SAGE Open Med Case Rep. 2023 Oct 5;11:2050313X231203463. doi: 10.1177/2050313X231203463. eCollection 2023.
Dieulafoy lesions are a rare but life-threatening cause of gastrointestinal bleeding. Colonic Dieulafoy lesions are exceptionally rare, comprising only 2% of these lesions. We present a case of cecal Dieulafoy lesion as an unusual cause of lower gastrointestinal bleeding-along with hemoptysis. An 81-year-old male with pulmonary hypertension presented with a one-day history of hematochezia. He subsequently developed new small-volume hemoptysis/hematemesis with increasing oxygen requirements. Bronchoscopy revealed old blood in the left lower lobe, with no active bleeding. The hemoptysis was attributed to severe pulmonary hypertension. Colonoscopy revealed a 2-mm cecal Dieulafoy lesion with spurting bleeding, which was clipped. We report a rare case of cecal Dieulafoy lesion with only 13 other published cases. Our case was complicated by hemoptysis creating an interesting diagnostic dilemma. In patients bleeding from both oral and anal orifices, a brisk upper gastrointestinal bleed-as well as independent causes involving the gastrointestinal and respiratory tracts-should be considered.
Dieulafoy病变是一种罕见但危及生命的胃肠道出血原因。结肠Dieulafoy病变极为罕见,仅占这些病变的2%。我们报告一例盲肠Dieulafoy病变,它是下消化道出血以及咯血的不寻常原因。一名患有肺动脉高压的81岁男性,有一天的便血病史。随后,他出现了新的少量咯血/呕血,且氧需求增加。支气管镜检查显示左下叶有陈旧性血液,无活动性出血。咯血归因于严重的肺动脉高压。结肠镜检查发现一个2毫米的盲肠Dieulafoy病变,有喷射性出血,予以夹闭。我们报告了一例罕见的盲肠Dieulafoy病变,此前仅有13例其他病例报道。我们的病例因咯血而复杂化,造成了一个有趣的诊断难题。在同时有口腔和肛门出血的患者中,应考虑上消化道大出血以及涉及胃肠道和呼吸道的独立病因。