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An unusual cause of lower gastrointestinal bleeding

¹ Department of Digestive Diseases, Hospital Ambroise Paré, Boulogne Cedex, France
² Department of Vascular Surgery, Hospital Ambroise Paré, Boulogne Cedex, France
³ Department of Digestive Diseases, Hospital Ambroise Paré, Boulogne Cedex, France
⁴ Department of Vascular Surgery, Hospital Ambroise Paré, Boulogne Cedex, France
⁵ Department of Radiology, Hospital Ambroise Paré, Boulogne Cedex, France

Correspondence to:
Correspondence to:
Dr G Lesur
Department of Digestive Diseases, Hôpital Ambroise Paré, 92104 Boulogne Cedex, France; gilles.lesur@apr.aphp.fr

Keywords: gastrointestinal bleeding; aneurysm; vascular-enteric fistula

The first 150 words of the full text of this article appear below.

Clinical presentation
A 94 year old woman with no history of gastrointestinal bleeding was admitted to her local hospital for acute lower gastrointestinal bleeding. There was a history of hypertension and hypothyroidism. Examination was unremarkable except for red stools noted on digital examination of the rectum. Emergency sigmoidoscopy revealed an adherent clot 15 cm from the anal verge and diverticulosis. She was transferred to our hospital because she had received many transfusions (9 units) but no diagnosis. On admission the patient was haemodynamically stable and stools contained no blood. Haemoglobin was 9.4 g/dl; white blood cell count was within the normal range. At colonoscopy, diverticulosis and a deep beating ulcer surrounding an elevated pulsatile area 15 cm from the anal verge was noted (fig 1). Complete examination of the colon was not possible, probably because of diverticulosis.

View larger version (110K): [in this window] [in a new window]   Figure 1  Endoscopic view showing a deep beating ulcer surrounding a surelevated pulsate zone in the . . . [Full text of this article]