|Patient: 53 year old female|
53 year old female with ischemic cardiomyopathy necesitating placement of a 2nd-generation left ventricular assist device (LVAD). The patient presents with a melena while on warfarin and clopidogrel. See figures 1-3
What is your interpretation of this study and what is the next step in management?
Findings and intervention performed? (figures 4-9)
What additional procedure may be helpful in determining a diagnosis? (see figure 10)
Gastro-intestinal Bleeding Scintigraphy:
RADIOPHARMACEUTICAL: 26.8 mCi Tc-99m in vitro labeled red cells i.v.
Lower gastrointestinal hemorrhage, specifically arising from the region of the cecum.
Coil embolization of distal branch of the ileocolic artery supplying the bleeding segment of the cecum. No evidence of active bleeding on the post coiling angiograms.
See figure 10 and general discussion
Other causes of lower gastrointestinal bleeding:
Advanced liver disease causing mucosal spider nevi
|Diagnosis: Dieulafoy Lesion|
General Discussion: |
53 year old female with ischemic cardiomyopathy necesitating placement of a 2nd-generation left ventricular assist device (LVAD). The patient presented with a G.I. bleed while on warfarin and clopidogrel. The initial GI bleeding study was positive but the initial angiogram and colonscopy were negative (images not included in this teaching file). The patient was subsequnetly sent home off of warfarin and clopidogrel but returned with a falling hematocrit and melena. Both the repeat GI bleeding study and angiography study were positive (images included in this teaching file). Repeat colonscopy was performed after the angiographic intervention demonstrating the Dieulafoy lesion, which was then treated endoscopically with epinephrine and clipping.
Discussion: Dieulafoy “ulcers”
Large tortuous arteriole in the submucosa that erodes the gastrointestinal wall.
< 5% of causes for gastrointestinal bleeding
No direct association alcohol abuse or NSAID use.
Treatment is primarily by endoscopic techniques
|References: Jain, Richa and Chetty, Runjan. "Dieulafoy Disease of the Colon." Arch Pathol Lab Med. 133; 1865-1867, 2008.|
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Case Number: 245472Owner(s): Andrew Homb and Jerold Wallis, Assoc Prof of RadiologyLast Updated: 12-15-2010 The reader is fully responsible for confirming the accuracy of this content.
The reader is fully responsible for confirming the accuracy of this content.