Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Medicine (Baltimore). 2024 Apr 19;103(16):e37871. doi: 10.1097/MD.0000000000037871.
The bleeding of Dieulafoy lesion predominantly involves the proximal stomach and leads to severe gastrointestinal bleeding. However, these lesions have also been reported in the whole gastrointestinal tract. Bleeding of Dieulafoy lesions at the anastomosis was seldomly reported and was very easy to be ignored clinically.
We describe a 72-year-old woman with a past history of surgery for rectal carcinoma hospitalized with chief complaint of massive rectal bleeding. No gross bleeding lesion was found during the first emergency colonoscopy. Despite multiple blood transfusions, her hemoglobin rapidly dropped to 5.8 g/dL.
She was diagnosed with Dieulafoy lesion at the colorectal anastomosis during the second emergency colonoscopy.
Primary hemostasis was achieved by endoscopic hemostatic clipping. However, she experienced another large volume hematochezia 3 days later, and then received another endoscopic hemostatic clipping. She was improved and discharged. However, this patient underwent hematochezia again 1 month later. Bleeding was arrested successfully after the over-the-scope clip (OTSC) was placed during the fourth emergency colonoscopy.
This patient underwent 4 endoscopic examinations and treatments during 2 hospitalizations. The lesion was overlooked during the first emergency colonoscopy. The second and third endoscopes revealed Dieulafoy lesion at the colorectal anastomosis and performed endoscopic hemostatic clippings, but delayed rebleeding occurred. The bleeding was stopped after the fourth emergency colonoscopy using OTSC. There was no further rebleeding during hospitalization and after 2-year of follow-up.
As far as we know, there is no reported case of lower gastrointestinal bleeding caused by Dieulafoy lesion at the colorectal anastomosis, OTSC is a safe and effective rescue treatment for Dieulafoy lesions.
Dieulafoy 病变的出血主要涉及胃近端，导致严重的胃肠道出血。然而，这些病变也已在整个胃肠道中报道过。Dieulafoy 病变在吻合口的出血很少见，临床上很容易被忽视。
我们描述了一位 72 岁的女性，既往有直肠癌手术史，因大量直肠出血而住院。首次紧急结肠镜检查未发现明显出血病灶。尽管多次输血，她的血红蛋白迅速降至 5.8 g/dL。
第二次紧急结肠镜检查诊断为结直肠吻合口 Dieulafoy 病变。
内镜止血夹夹闭实现了初步止血。然而，她在 3 天后再次出现大量血便，随后再次接受内镜止血夹夹闭。她的病情得到改善并出院。然而，该患者在 1 个月后再次出现血便。在第四次紧急结肠镜检查中放置过内镜用全覆膜金属夹（OTSC）后，出血得到了成功止血。
该患者在 2 次住院期间共接受了 4 次内镜检查和治疗。第一次紧急结肠镜检查时忽略了病变。第二次和第三次内镜检查显示结直肠吻合口的 Dieulafoy 病变，并进行了内镜止血夹夹闭，但出现延迟性再出血。第四次紧急结肠镜检查使用 OTSC 止血成功。住院期间和 2 年随访期间无再出血。
据我们所知，尚无报道称结直肠吻合口的 Dieulafoy 病变引起下消化道出血，OTSC 是治疗 Dieulafoy 病变的一种安全有效的抢救治疗方法。
