Abstract
Dieulafoy’s ulcer occurs throughout the digestive tract, but rectal Dieulafoy’s ulcer is considered to be rare. Rapid diagnosis and treatment of rectal Dieulafoy’s ulcer is required in order to avoid fatalities associated with serious gastrointestinal bleeding. We report herein two cases of rectal Dieulafoy’s ulcer that were successfully diagnosed and treated by colonoscopy.
Case 1：A 60-year-old woman with diabetes and hypertension was admitted to our hospital for recurring hematochezia and anemia. Emergency colonoscopy revealed heavy bleeding without obvious ulcers in the rectum. Pressure from a transparent hood on the endoscope enabled identification of the bleeding vessel. We diagnosed rectal Dieulafoy’s ulcer, and treated with endoscopic clips. The patient was discharged without rebleeding.
Case 2：During hospitalization for SLE, a 60-year-old woman underwent emergency surgery for colon perforation and panperitonitis. Ten days after surgery, hematochezia occurred. Colonoscopy identified a blood clot in the rectum. After removal of the blood clot, heavy bleeding from the vessel occurred without the presence of an obvious ulcer. We diagnosed rectal Dieulafoy’s ulcer. Bleeding of the exposed vessel was treated using endoscopic clips.
Careful endoscopic observation is essential even if an ulcer is not obvious, as there is a possibility of Dieulafoy’s ulcer. Endoscopic clipping using a transparent hood is the preferred hemostatic technique for treatment of bleeding from rectal Dieulafoy’s ulcers.
