S4740 Cecal Dieulafoy’s Lesion Presenting as Post-Polypectomy Hematochezia: A Rare and Overlooked Cause of Lower GI Bleeding

Introduction: Dieulafoy’s lesions (DLs) are a rare but life-threatening source of gastrointestinal hemorrhage, caused by a large-caliber submucosal artery that erodes through a small mucosal defect without associated ulceration. While typically gastric, colonic DLs are rare, comprising <2% of cases. We report a case of a 70-year-old man who presented with hematochezia 8 days after screening colonoscopy with polypectomy. A cecal DL was identified on endoscopy and successfully managed with hemoclipping and epinephrine injection. Case Description/Methods: A 70-year-old man with hypertension, type 2 diabetes mellitus, hyperlipidemia, chronic kidney disease stage 2, metabolic dysfunction-associated steatotic liver disease, diverticulosis, and internal hemorrhoids presented with 3 episodes of bright red blood per rectum and associated lightheadedness. Eight days earlier, he had a screening colonoscopy with cold snare removal of 2 3 mm hyperplastic polyps in the cecum and descending colon. On arrival, he was tachycardic (126 bpm) and hypotensive. Labs revealed hemoglobin of 13.8 g/dL, later falling to 10.6 g/dL, and then to ∼8 g/dL during a syncopal episode. Computed tomography angiography showed no active extravasation but was limited by hip prosthesis artifact. Colonoscopy on hospital day 2 revealed active bleeding from a DL near the appendiceal orifice, distinct from the previous polypectomy site. Three hemoclips were placed, and epinephrine was injected to achieve hemostasis. The patient remained stable with no further bleeding. He was discharged in stable condition with plans for outpatient follow-up. Discussion: Colonic DLs are rare and often underrecognized causes of lower gastrointestinal bleeding. These lesions involve a dilated submucosal artery that can cause significant hemorrhage through a small mucosal defect. While gastric DLs are well documented, cecal lesions may be mistaken for more common causes like diverticulosis or post-polypectomy bleeding. This case is notable for its temporal proximity to colonoscopy, which initially led to suspicion of post-polypectomy bleeding. However, endoscopy localized the DL near the appendiceal orifice, far from the prior polypectomy site, emphasizing the need for careful mucosal inspection. Computed tomography angiography was inconclusive illustrating the limits of radiographic imaging. Colonoscopy remains the diagnostic and therapeutic gold standard. Endoscopic treatment using epinephrine and hemoclips is highly effective in achieving hemostasis and preventing rebleeding. Prompt recognition and intervention can be lifesaving and may prevent surgical approaches.