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Lower gastrointestinal haemorrhage: case report A 79-year-old man developed lower gastrointestinal haemorrhage following antiplatelet therapy with aspirin and clopidogrel. The man had a medical history of coronary artery disease and 5 years ago, and he had undergone single drug-eluting stent placement to the right coronary artery. Eventually, he presented with constipation followed by lower abdominal pain, dizziness and multiple episodes of large volume haematochezia. At that time, he was receiving antiplatelet therapy with aspirin and clopidogrel [routes and dosages not stated]. Upon presentation, he appeared pale and had tenderness to palpation in the left lower quadrant with active large volume haematochezia. Due to the ongoing bleeding, drop in BP and haematochezia with tachycardia, he was admitted. Laboratory investigations showed a haemoglobin of 8.1 g/dL that decreased to 6.2 g/dL after recurrence of haematochezia [time to reactions onset not stated]. The man required transfusion of 4 packed RBCs. Abdominal CT angiogram demonstrated focal wall thickening of the distal sigmoid colon and active contrast extravasation suggestive of active haemorrhage. In view of recurrent bleeding and haemodynamic instability, endoscopic evaluation was not performed. Interventional radiology demonstrated that the active extravasation was associated with pseudoaneurysm in the distal branch of the superior rectal artery (SRA). He then underwent successful coil embolisation and remained haemodynamically stable. For gastrointestinal haemorrhage, pseudoaneurysm in the distal branch of the SRA, and therapy of aspirin and clopidogrel were considered as contributing factors. Nguyen C, et al. Lower gastrointestinal hemorrhage caused by superior rectal artery pseudoaneurysm. ACG Case Reports Journal 7: e00387, No. 6, Jun 2020. Available from: 803517966 URL: http://doi.org/10.14309/crj.0000000000000387

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Reactions 28 Nov 2020 No. 1832