Dieulafoy’s Lesion of the Anal Canal: A Rare Cause of Lower Gastrointestinal Bleeding

Case series Patient: Male, 48 • Female, 85 Final Diagnosis: Dieulafoy’s lesion of the anal canal Symptoms: Bleeding per rectum Medication: — Clinical Procedure: Anoscopy or sigmoidoscopy Specialty: General Surgery OBJECTIVE: Challenging differential diagnosis BACKGROUND: Dieulafoy’s lesion of the anal canal is an uncommon cause of lower gastrointestinal bleeding due to rupture of a submucosal artery. This could be an under-recognized cause of hemorrhagic shock in rare cases. CASE REPORT: We present 2 cases admitted with bleeding per rectum and hemorrhagic shock, and both were diagnosed as Dieulafoy’s lesion of the anal canal on sigmoidoscopy. One case was treated surgically and the second was managed endoscopically. CONCLUSIONS: Dieulafoy’s lesion of the anal canal can be a source of massive lower gastrointestinal bleeding. Initial anoscopy or sigmoidoscopy might miss such a lesion. Proper visualization helps not only the diagnosis, but also the provision of therapeutic intervention in the same setting.