Dieulafoy lesion in a Hartmann stump

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Surgical Pathology

Background:

• Sigmoid carcinoma treatment can involve complex procedures like laparoscopic anterior resection and Hartmann procedures.
• Bowel ischemia and anastomotic leakage are known complications following colorectal surgery.
• Massive hemorrhage from the rectal stump is a rare but serious postoperative complication.

Observation:

• A 70-year-old male presented with massive rectal bleeding and hematochezia post-Hartmann procedure for sigmoid carcinoma.
• Exploratory surgery failed to identify the bleeding source; the rectal stump was closed with a Foley catheter.
• Transanal colonoscopy revealed a Dieulafoy lesion in the rectal stump with active arterial bleeding.

Findings:

• Endoscopic hemostasis attempts were unsuccessful.
• Transanal suturing was successfully employed to achieve hemostasis.
• The patient recovered without recurrent bleeding during an 18-month follow-up.

Implications:

• This case highlights the possibility of Dieulafoy lesions occurring in rectal stumps after Hartmann procedures.
• Transanal suturing presents a viable, minimally invasive option for managing Dieulafoy lesions in this specific clinical scenario.
• Further research may explore the incidence and optimal management of rectal Dieulafoy lesions in patients with diverted colonic segments.