Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 25, 2016; 8(16): 568-571
Published online Aug 25, 2016. doi: 10.4253/wjge.v8.i16.568
Small bowel Dieulafoy lesions: An uncommon cause of obscure bleeding in cirrhosis
Grainne Holleran, Mary Hussey, Deirdre McNamara
Grainne Holleran, Mary Hussey, Deirdre McNamara, Trinity Academic Gastroenterology Group, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland
Author contributions: All authors contributed to this paper.
Institutional review board statement: This case series was exempt from approval by the Tallaght Hospital/St James’s Hospital Joint Research Ethics Committee (REC).
Informed consent statement: All involved subjects were contacted and gave verbal consent to their anonymised inclusion in this report.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Grainne Holleran, Gastroenterology Registrar, Trinity Academic Gastroenterology Group, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland. hollerag@tcd.ie
Telephone: +353-18-963844 Fax: +353-18-962988
Received: March 29, 2016
Peer-review started: March 31, 2016
First decision: May 17, 2016
Revised: May 28, 2016
Accepted: June 27, 2016
Article in press: June 29, 2016
Published online: August 25, 2016
Abstract

Dieulafoy lesions (DLs) are an uncommon cause of gastrointestinal bleeding, accounting for up to 2% of cases overall. They are largely under recognised and difficult to treat. Up to 95% occur in the stomach, and only case reports document their occurrence in the small bowel (SB). Little is known about their pathophysiology, although there have been associations made previously with chronic liver disease, thought to be due to the erosive effects of alcohol on the mucosa overlying the abnormally dilated vessels. We present a case series of 4 patients with a long duration of obscure gastrointestinal bleeding, who were diagnosed with small intestinal DLs and incidentally diagnosed with chronic liver disease. The histories describe the challenges in both diagnosis and treatment of small intestinal DLs. Our case series suggest a previously unreported link between chronic liver disease and SB DLs which may be due to anatomical vasculature changes or a shift in angiogenic factors as a consequence of portal hypertension or liver cirrhosis.

Keywords: Obscure gastrointestinal bleeding, Dieulafoy lesions, Cirrhosis, Portal hypertension, Capsule endoscopy, Double balloon enteroscopy

Core tip: Patients with advanced liver disease are known to have a high rate of obscure gastrointestinal bleeding, the cause of which is often left undetected. Our case series suggests that there may be an increased risk of small intestinal Dieulafoy lesions (DLs) in patients with cirrhosis. Although the pathophysiology of DLs is unknown, our case series of jejunal lesions in patients with cirrhosis raises the question of a potential alteration in the vasculature secondary to portal hypertension, as either an anatomical abnormality or due to a shift in angiogenic factors in these patients.