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Adult small bowel Dieulafoy lesion.
1Department of Upper Gastrointestinal and Hepatobiliary Surgery, John Radcliffe Hospital Headington, Oxford, UK. andreasfox@hotmail.com
Postgraduate Medical Journal
|November 28, 2001
Summary
A Dieulafoy lesion, a rare cause of gastrointestinal bleeding, was found in the small intestine of an adult woman. This is the first documented case of an ileal Dieulafoy lesion in an adult.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Surgical Pathology
Background:
- Dieulafoy lesions are a rare cause of acute gastrointestinal bleeding, typically originating in the stomach.
- Diagnosis can be challenging due to intermittent bleeding and lack of endoscopic visualization.
- Arteriovenous malformations (AVMs) in the small intestine are uncommon causes of obscure gastrointestinal bleeding.
Observation:
- A 47-year-old female presented with severe melaena and hemodynamic instability.
- Initial investigations, including endoscopy, did not identify the bleeding source.
- Laparotomy revealed an arteriovenous malformation in the distal ileum.
Findings:
- Histopathological examination confirmed the ileal arteriovenous malformation to be a Dieulafoy lesion.
- This represents the first reported case of a histologically proven adult ileal Dieulafoy lesion.
- Dieulafoy lesions are characterized by a focal defect in the submucosal artery.
Implications:
- This case expands the known anatomical locations for Dieulafoy lesions.
- Highlights the importance of considering Dieulafoy lesions in cases of obscure gastrointestinal bleeding, even in the small intestine.
- Suggests that surgical intervention may be necessary when endoscopic methods fail to identify the source of severe gastrointestinal hemorrhage.