Jejunal Dieulafoy lesion causing massive gastrointestinal bleed.

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Dieulafoy lesions are rare, non-variceal causes of significant gastrointestinal bleeding.
• These lesions arise from abnormal submucosal arteries and can lead to substantial morbidity and mortality if not diagnosed.
• Obscure small bowel bleeding presents significant diagnostic and therapeutic challenges.

Purpose of the Study:

• To present a case of massive obscure gastrointestinal bleeding caused by a Dieulafoy lesion.
• To highlight the diagnostic utility of capsule endoscopy in identifying obscure small bowel bleeding sources.
• To emphasize the importance of timely surgical intervention for managing massive obscure GI bleeds.

Main Methods:

• A case report of a young female patient with massive upper and lower gastrointestinal bleeding and hemodynamic instability.
• Initial investigations included upper and lower endoscopy and radiological studies, which failed to identify the bleeding source.
• Capsule endoscopy was utilized to pinpoint the bleeding source in the mid-jejunum.
• Emergency laparotomy with resection and anastomosis of the affected bowel segment was performed.

Main Results:

• The source of massive obscure gastrointestinal bleeding was identified as a Dieulafoy lesion in the mid-jejunum using capsule endoscopy.
• Despite negative initial endoscopic and radiological findings, capsule endoscopy proved effective in localization.
• Successful surgical management was achieved through resection and anastomosis, resolving the bleeding.

Conclusions:

• Massive obscure small bowel bleeding poses significant diagnostic and therapeutic challenges.
• Capsule endoscopy is a valuable tool for diagnosing obscure gastrointestinal bleeding when conventional methods fail.
• Timely surgical intervention is crucial for effective management of life-threatening obscure small bowel bleeds from Dieulafoy lesions.