A Case of Secondary Amyloidosis Presenting as Massive Gastrointestinal Bleeding / 대한소화기학회지

Amyloidosis is a disorder characterized by extracellular deposition of amyloid in various tissues and organs. Gastrointestinal manifestations including gastroparesis, constipation, malabsorption, intestinal pseudo-obstruction, and bleeding are common. GI bleeding is a rare initial symptom which can be fatal in some cases. Absence of systemic symptoms and nonspecific endoscopic findings in amyloidosis may make diagnosis difficult. Therefore, amyloidosis-induced GI bleeding should be considered in patients with an obscure hemorrhage. Recently, we experienced a 65-year-old woman who presented with massive hematochezia as a manifestations of amyloidosis. Colonoscopy and SMA angiography showed massive bleeding in the small and large intestine. Colonoscopic biopsy established amyloidosis. We report this case with a review of the relevant literatures.

A Dieulafoy-like Lesion of the Rectum as a Cause of Massive Lower G-I Bleeding / 대한소화기내시경학회지

Dieulafoy's lesion is an exposed submucosal artery associated with a minute mucosal defect in the stomach, and it is a rare cause of profuse, but intermittent gastrointestinal bleeding. Less commonly, similar lesions have been identified in the duodenum, jejunum, colon, and in rare cases, the rectum. Only four cases of rectal Dieulafoy's lesion have been reported in English Medical literature: one case involved a child, two in otherwise healthy young men, and one in on elderly man. In this report, two elderly men are described, who suffered an massive hematochezia from a small rectal mucosal defect with a visible vessel. Control of the bleeding was successfully achieved with on endoscopic sclerotherapy or hemoclipping. The fact that rectal Dieulafoy disease is one of the causes of massive hematochezia should serve as a reminder in future cases, especially involving alcoholics and elderly men.