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Diagnostic and after therapeutic intervention endoscopic findings. (a) Active cecal mucosal bleeding (arrow). (b) After irrigation, bleeding noted from an isolated, single spot (arrow). (c) After 10 cc of normal saline-epinephrine (1:10000) injection, bleeding persisted from the identified spot without apparent underlying lesion (arrow). (d) Hemostasis was achieved after a few applications of bipolar coagulation. No definite lesion can be seen except evidence of iatrogenic electrocautery (arrow).
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Colonoscopy revealed a localized area of active, mucosal bleeding at the cecum (Fig. 1a,b) without evidence of Dieulafoy lesion, ulcer, mass, arteriovenous malformation, or diverticula. Initial hemostasis was not successful with 10 cc of 1% normal saline-epinephrine solution (Fig. 1c). Hemostasis was ultimately achieved after application of bipolar electrocautery (Fig. 1d).