Open AccessObscure bleeding colonic duplication responds to proton pump inhibitor therapy
Author(s) -
J. Jacques,
Fabrice Projetti,
Romain Legros,
Virginie Valgueblasse,
Matthieu Sarabi,
Paul Carrier,
Fabien Fredon,
Stéphane Bouvier,
Véronique LoustaudRatti,
Denis Sautereau
Publication year - 2013
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v19.i35.5940
Subject(s) - medicine , exploratory laparotomy , colonoscopy , lower gastrointestinal bleeding , capsule endoscopy , gastrointestinal bleeding , laparotomy , proton pump inhibitor , gastroenterology , surgery , colorectal cancer , cancer
We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding. Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5 and 2 years previously. An emergency abdominal computed tomography scan, gastroscopy and colonoscopy, performed after hemodynamic stabilization, were considered normal. High-dose intravenous proton pump inhibitor (PPI) therapy was initiated and bleeding stopped spontaneously. Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy. This showed long tubular duplication of the right colon, with fresh blood in the duplicated colon. Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening. The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy. Obscure gastrointestinal bleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel's diverticulum or gastrointestinal duplication, and gastroenterologists should be aware of this potential medical situation.