A RARE CAUSE OF RECTAL BLEEDING

A 38-year-old woman was evaluated in the Gastrointestinal Endoscopy service due to rectal bleeding. Fifteen days before, she had been hospitalized in another institution for hypovolemic shock associated with bleeding from the digestive tract. Due to this, panendoscopy and colonoscopy were performed, without documenting bleeding site at a higher level. Only, abundant fresh hematic remains were found in the left colon. Bleeding occurred intermittently with abundant volume, associated with altered mental status and hypotension. Due to the persistence of these symptoms, subtotal colectomy was performed. Despite this, the bleeding events persisted, so an assessment was requested in our hospital. During the review, the primary anastamosis site showed active minor bleeding. The remnant of the rectum initially did not present hematic remains either. During the endoscopic examination, a visible vessel surrounded by healthy mucosa, located 4 cm from the anal margin, was observed. An attempt was made to perform hemostasis with band ligation, without success, after which he presented active bleeding. A Dieulafoy lesion was diagnosed. Mechanical hemostasis was performed with direct compression by digital rectal examination and subsequently two hemoclips were applied, with satisfactory control of bleeding. The patient was discharged one week later, without new bleeding events and oral iron supplementation.