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Case Reports in Gastrointestinal Medicine
Volume 2014, Article ID 436293, 4 pages
http://dx.doi.org/10.1155/2014/436293
Case Report

Colonic Dieulafoy’s Lesion: A Rare Cause of Lower Gastrointestinal Hemorrhage and Review of Endoscopic Management

1Department of Internal Medicine, University of Alberta, 13-103 Clinical Sciences Building, Edmonton, AB, Canada T6G 2G3
2Division of Gastroenterology, University of Calgary, Teaching Research Wellness Building, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6

Received 13 July 2014; Accepted 5 October 2014; Published 19 October 2014

Academic Editor: Antonio Macrì

Copyright © 2014 Christopher Ma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Dieulafoy’s lesions are a rare cause of gastrointestinal hemorrhage. Extragastric Dieulafoy’s lesions are even more uncommon. We report the case of a 75-year-old woman who presented with gastrointestinal bleeding from a transverse colonic Dieulafoy’s lesion. She presented with two episodes of melena followed by one episode of fresh blood per rectum. In addition, there was associated presyncope and anemia (hemoglobin 69 g/L) in the setting of supratherapeutic warfarin anticoagulation (INR 6.2) for nonvalvular atrial fibrillation. Esophagogastroduodenoscopy was negative for an upper GI source of bleeding but on colonoscopy an actively oozing Dieulafoy’s lesion was identified in the transverse colon. Bipolar cautery and hemostatic endoclips were applied to achieve hemostasis. Clinicians should consider this rare entity as a potential cause of potentially life-threatening lower gastrointestinal bleeding and we review the endoscopic modalities effective for managing colonic Dieulafoy’s lesions.