Abstract:

Dieulafoy’s lesion is rare but life-threatening cause of lower gastrointestinal hemorrhage. In this study it is aimed to present a case of Dieulafoy lesion in anal canal which causes massive lower gastrointestinal hemorrhage and mortality. A 72 year-old male patient with massive lower gastrointestinal bleeding applied to the hospital. Since no lesion was detected on colonoscopy and scintigraphy, emergency laparotomy was performed for the unstable patient. On the intraoperative colonoscopy, a lesion was located proximal to anal canal and clipped. Despite the absence of rebleeding, the patient died due to respiratory complications associated with massive transfusion at the eighth day of his postoperation. For this kind of lesions, mortality rates were reported as up to 80%. In this case, the lesion was not found on evaluation performed under emergency setting. Although it is rare, Dieulafoy lesion should be kept in mind in patients with massive lower gastrointestinal hemorrhage. For treatment, conservative methods such as selective arterial embolisation, sclerotherapy, epinephrine injection, thermocoagulation and clips application can be used. When the location of bleeding was not revealed in preoperative evaluation, colonoscopy can be used during surgery. In case of delayed diagnosis the hemorrhage may be kept under control; however, morbidity and mortality may increase with massive transfusion.

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