Dieulafoy Lesion in the Ascending Colon Presenting with Gastrointestinal Bleeding and Severe Anemia Complicated by a Coexisting Severe Resistant Chronic Idiopathic Thrombocytopenic Purpura

Figure 1

Procedure: Olympus colonoscope was advanced from the anus under direct visualization to the cecum. Cecum was confirmed by appendiceal orifice and ileocecal valve. There was large amount of clots and blood throughout the colon, and there was active bleeding from the proximal ascending colon. After irrigation it appeared to be from a Dieulafoy lesion at the proximal ascending colon with active bleeding. Two endoclips were placed with excellent hemostasis. It was decided not to use cautery due to the patient’s thrombocytopenia. Due to the presence of large amount of old blood and clots throughout the colon, polyps cannot be ruled out, so this procedure was not optimal for screening purposes. The patient tolerated the procedure very well and there was no immediate complication associated with the procedure.

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