A case of dialysis patient diagnosed with isolated PJS due to bloody stool while taking DAPT

Abstract

A 65-year-old man taking dual antiplatelet therapy (DAPT) on maintenance dialysis for chronic renal insufficiency was rescued to our hospital by chief complaint of bloody stool in 2019. Contrast-enhanced CT showed extravasation of the contrast agent into the ileum, and he was hospitalized with a diagnosis of small intestinal bleeding. Blood stool disappeared after discontinuation of DAPT. Small intestinal endoscopy revealed a 25 mm-sized polyp with erosion in the ileum, which was considered a bleeding source. Based on the risk of rebleeding due to DAPT resumption, EMR was performed, and Peutz-Jeghers type polyp was diagnosed. With the aging, the number of patients taking DAPT is expected to increase. Small intestinal polyps, which had previously been asymptomatic, may cause gastrointestinal bleeding due to oral administration of DAPT, which may increase the frequency of detection. In gastrointestinal bleeding from the small intestine of patients receiving DAPT, it was considered important to remind bleeding from polyps such as in this case.