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Dieulafoy’s Lesion of the Right Colon: Report of Two Cases
Poster Abstract

Background

Dieulafoy’s lesion (DL) is an uncommon vascular anomaly capable of causing severe gastrointestinal bleeding. Although it most frequently occurs in the stomach, colonic localization—particularly in the right colon—is rare and may delay diagnosis and management. We describe two patients, recently diagnosed and treated in our department.

Case Reports

Case 1:A 77-year-old woman with a history of atrial fibrillation receiving acenocoumarol presented with anemia (Hgb 9.3 g/dL; Hct 28.7%; MCV 97 fL) and dark red stools. Acenocoumarol was discontinued, and fluid resuscitation along with PPI therapy was initiated. Upper endoscopy identified a small prepyloric Forrest III ulcer (0.6 cm), deemed insufficient to explain the bleeding. Due to ongoing gastrointestinal bleeding and transfusion requirements, colonoscopy was performed and revealed a capillary bleeding point in the ascending colon consistent with a Dieulafoy’s lesion. Argon plasma coagulation (APC) achieved successful hemostasis.

Case 2:An 80-year-old woman with coronary artery disease and atrial fibrillation, on daily clopidogrel and apixaban, presented with severe anemia (Hgb 3.3 g/dL; Hct 10.3%; MCV 93.7 fL) and dark red stools. Management included PPI therapy, transfusion of red blood cells, fresh frozen plasma, and temporary suspension of anticoagulation. Upper endoscopy showed no source of bleeding. Because symptoms persisted, colonoscopy was performed and revealed a Dieulafoy’s lesion in the ascending colon. Hemostasis was achieved using three endoscopic clips. Low-molecular-weight heparin was later restarted without hemorrhagic recurrence.

Conclusion

Both patients recovered uneventfully and were discharged in stable condition. These cases illustrate that in patients with ongoing gastrointestinal bleeding and negative upper endoscopy, early colonoscopy should be strongly considered. Prompt evaluation can prevent unnecessary repeated procedures and allows timely diagnosis and effective endoscopic treatment of rare but clinically significant colonic Dieulafoy’s lesions.