title: Obscure bleeding colonic duplication responds to proton pump inhibitor therapy.
abstract: 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.
authors.affiliation: Jérémie Jacques, Fabrice Projetti, Romain Legros, Virginie Valgueblasse, Matthieu Sarabi, Paul Carrier, Fabien Fredon, Stéphane Bouvier, Véronique Loustaud-Ratti, Denis Sautereau, Service d'Hépato-gastro-entérologie, CHU Dupuytren, 87042 Limoges, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Jacques
authors.forename: Fabrice
authors.initials: F
authors.lastname: Projetti
authors.forename: Romain
authors.initials: R
authors.lastname: Legros
authors.forename: Virginie
authors.initials: V
authors.lastname: Valgueblasse
authors.forename: Matthieu
authors.initials: M
authors.lastname: Sarabi
authors.forename: Paul
authors.initials: P
authors.lastname: Carrier
authors.forename: Fabien
authors.initials: F
authors.lastname: Fredon
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bouvier
authors.forename: Véronique
authors.initials: V
authors.lastname: Loustaud-Ratti
authors.forename: Denis
authors.initials: D
authors.lastname: Sautereau
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D002828:Choristoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005753:Gastric Mucosa; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012007:Rectum; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Colonic duplication; Gastro-intestinal duplication; Gastrointestinal bleeding; Hemostatic colorectal surgery; Proton pump inhibitor therapy