Culprit for recurrent acute gastrointestinal massive bleeding: “Small bowel Dieulafoy’s lesions” - a case report and literature review

Abstract

A Dieulafoy's lesion is a dilated, aberrant, submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It can be located anywhere in the gastrointestinal tract. We describe a case of massive gastrointestinal bleeding from Dieulafoy’s lesions in the duodenum. Etiology and precipitating events of a Dieulafoy’s lesion are not well known. Bleeding can range from being self-limited to massive life- threatening. Endoscopic hemostasis can be achieved with a combination of therapeutic modalities. The endoscopic management includes sclerosant injection, heater probe, laser therapy, electrocautery, cyanoacrylate glue, banding, and clipping. Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection. Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis, angiographic embolization or surgical wedge resection of the lesions. We present a 63-year-old Caucasian male with active bleeding from the two small bowel Dieulafoy’s lesions, which was successfully controlled with epinephrine injection and clip applications.

Keywords: Dieulafoy’s lesion, Small intestine, Massive bleeding, Endoscopic treatment, Endoscopy, Surgery

Core tip: Small bowel Dieulafoy’s lesion is a rare entity that can cause severe life threatening gastrointestinal hemorrhage. It is difficult to diagnose and treat a small bowel Dieulafoy’s lesion by initial endoscopy unlike most gastric Dieulafoy’s lesions. We report a rare presentation of small bowel Dieulafoy’s lesions in a 63-year-old male. The hemorrhage was successfully controlled by epinephrine injection and clip applications. We also reviewed small bowel Dieulafoy’s lesion studies and reports in the literature.