Rare Colonic Dieulafoy Lesions: A Case Series

Dieulafoy lesions (DLs) are infrequent causes of gastrointestinal bleeding (GIB) but can cause hemorrhage with a high risk of re-bleeds. They are most noted in the stomach, but this case series of three colonic DLs highlights even more rare causes of lower GIB. Three patients presented with blood loss and were found to have colonic DLs. All of them had esophagogastroduodenoscopies (EGDs) that were unremarkable, and they subsequently underwent a colonoscopy, which then showed oozing DLs. First, a 63-year-old woman had a week of maroon-colored stools but no use of blood thinners, prior GIB, or peptic ulcers. Next, an 81-year-old man presented with dyspnea and had a two-week history of melena. Three years later, he presented with two oozing lesions on a colonoscopy, which likely indicated a repeat DL. This was followed by multiple admissions for GIB. The lesions in these two cases were treated with epinephrine and hemostatic clips. Lastly, a 49-year-old man presented with hematochezia leading to shock, requiring transfusions, vasopressors, and ICU care. Computed tomography angiography (CTA) showed intraluminal contrast extraversion in the ascending colon, leading to interventional radiology (IR)-guided coil for suspected DL. Diagnosis can be hard, but early identification through endoscopy can help decrease mortality rates. Therefore, it is crucial to keep this on the list of differential diagnoses in cases with no other identifiable sources to allow for timely management.