Gastrointestinal Bleeding from Dieulafoy's Lesion in the Cecum

Dieulafoy's lesion is a rare cause of gastrointestinal (GI) bleeding comprising approximately 2% of all acute GI bleeds. It is an abnormal submucosal artery that has a tortuous course before protruding through the mucosa and leading to hemorrhage. Dieulafoy's lesions are most commonly located in the upper GI tract within the lesser curvature of the stomach. Lower GI tract Dieulafoy's lesions are remarkably rare. Our case describes an elderly gentleman who presented with fatigue and dyspnea several days prior to experiencing any evidence of GI bleeding. Initial laboratory investigation revealed severe anemia, requiring packed red blood cell transfusion. Endoscopic examination revealed a cecal Dieulafoy's lesion with active spurting of blood. Hemostasis was achieved through local epinephrine injection and hemostatic clipping. Previously reported cases of cecal Dieulafoy's lesions involve variable presentations including hematochezia, melena, or bright red blood per rectum. These lesions can be treated by angiography, surgically, or endoscopically via techniques that include epinephrine or ethanol injection, argon plasma coagulation, heater probe coagulation, hemostatic clips, or band ligation. Dieulafoy's lesions of the lower GI tract should be considered when no clear culprit is discovered, particularly with the concomitant use of antiplatelet agents and anticoagulants.