Dieulafoy Lesion (Forrest Ia Bleeding)
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
This is a 79-year-old white male patient who was admitted to the hospital with acute gastrointestinal bleeding. Patient reported sudden rectal passage of bright red blood. At the time of admission, patient exhibited circulatory instability. Colonoscopy was performed without prior bowel irrigation.
The video recording begins in the rectum. Fresh blood and a non-bleeding vascular stump are recognized. After slight manipulation, there is renewed arterial bleeding, which is controlled using a clip. A second clip is required for complete hemostasis.
If the patient’s general condition allows, emergency colonoscopy should be preceeded by intestinal irrigation whenever possible. In this case, the bleeding souce was within the rectum at a height of about 6 cm and visibility was not significantly impeded. A Dieulafoy lesion in the lower digestive tract is a very rare cause of bleeding. When clips are applied, it is important to assure that the arms of the clip enclose an adequate amount of tissue to compress the bleeding vessel.