P2474 - An Extremely Rare Cause of Lower Gastrointestinal Bleeding: Dieulafoy's Lesion Of Rectum

Shreel H. Patel, MD¹, Nirav B. Patel, MS², Hareesh Gundlapalli, MD³, Roy Subhash Kondapavuluru, MD¹, Kashif Ali, MD⁴, Dhruvkumar Patel, MBBS⁵, Saba Irfan, MBBS⁶, Viraj Panchal, MBBS⁷, Sudheer Kumar Kanumuri, MBBS⁸, Sameer Deshmukh, MBBS⁹, Nihar Gami, MBBS², Valeska Balderas, MD¹⁰, Fatimah Bello, MD¹, Jawairia Memon, MD^11
1University of Texas Rio Grande Valley - Knapp Medical Center, Weslaco, TX; ²GCS Medical College, Hospital and Research Centre, Weslaco, TX; ³University of New Mexico, San Antonio, TX; ⁴University of Texas Rio Grande Valley, Edinburg, TX; ⁵LSU Health Science Center, Shreveport, LA; ⁶Michigan State University, Weslaco, TX; ⁷Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ⁸Alluri Sitaram Raju Academy of Medical Sciences, Weslaco, TX; ⁹Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India; ¹⁰Texas Gastroenterology Institute, McAllen, TX; ¹¹UTHSCSA, San Antonio, TX

Introduction: Acute Lower Gastrointestinal Bleeding refers to acute blood loss from the colon. The causes are divided as anatomic, vascular, inflammatory and neoplastic. The patients usually present with hematochezia which might be bright red or maroon depending on where it is coming. The most common causes are diverticulosis, internal and external hemorrhoids, IBD, mass or tumors, infectious, ischemic or radiation induced. Therefore, we present a very rare case of lower GI bleeding secondary to the Dieulafoy’s lesion of rectum, as Dieulafoy’s lesion is very rare to be diagnosed in rectum.

Case Description/Methods: A 69-year-old lady with history of the coronary artery disease and non-healing ulcer on left foot presented to the ED with the chief complaint of the fever, chills and purulent drainage from the wound. She was started on treatment for osteomyelitis and was improving, suddenly overnight in that same hospital stay, the patient started having the massive painless bright red blood per rectum without any inciting cause. Labs were drawn, hemoglobin of 5 gram/dl and hematocrit of 22 % which dropped from her baseline hemoglobin of 11.8 gram/dl, INR was 1.1, Platelets were 233, and lactic acid was 2. The patient became hemodynamically decompensated, was hypotensive and tachycardic. Immediately was transferred to ICU and massive transfusion protocol was started and central line was placed for rapid blood transfusion. After some time, the bleeding was stopped and the patient underwent bowel prep and colonoscopy was done, which showed the Dieulafoy’s lesion of rectum which was treated with Endo clip. The patient also underwent EGD to rule out any other lesion. The patient was recommended to follow up with outpatient gastroenterologist for monitoring of any alarming signs.

Discussion: Dieulafoy’s lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying mucosa, without primary ulceration or erosion. It is most commonly seen in the stomach and small intestine. Currently, rectal lesions account for less than 2% of all Dieulafoy’s lesions, still making it an extremely rare cause of gastrointestinal bleeding. Patients with Dieulafoy’s lesion of rectum present with massive painless lower GI bleeding and hemodynamic instability. The mainstay of treatment for any Dieulafoy’s lesion remain the same with endoscopically by band ligation, Epinephrine or Endo clip, rarely it might require surgical intervention.



Disclosures:


Shreel H. Patel, MD¹, Nirav B. Patel, MS², Hareesh Gundlapalli, MD³, Roy Subhash Kondapavuluru, MD¹, Kashif Ali, MD⁴, Dhruvkumar Patel, MBBS⁵, Saba Irfan, MBBS⁶, Viraj Panchal, MBBS⁷, Sudheer Kumar Kanumuri, MBBS⁸, Sameer Deshmukh, MBBS⁹, Nihar Gami, MBBS², Valeska Balderas, MD¹⁰, Fatimah Bello, MD¹, Jawairia Memon, MD¹¹. P2474 - An Extremely Rare Cause of Lower Gastrointestinal Bleeding: Dieulafoy's Lesion Of Rectum, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.