Successful surgical treatment of a Dieulafoy's lesion of the jejunum localized with intraoperative endoscopy: a case report

Gastrointestinal (GI) bleeding can be a life-threatening condition. Obscure GI hemorrhage is occult bleeding from a location difficult to find with standard investigations. One cause of obscure GI bleeding is Dieulafoy's Lesion (DL), a very rare cause that can become potentially lethal. A DL is a normal vessel that has an abnormally large caliber (constant width of 1-3 mm). It runs a tortuous course within the submucosa and typically this vessel protrudes through a small opening in the mucosa, which has fibrinoid necrosis at the base. The location of DL is usually in the stomach with smaller frequency in the duodenum and colon. Other locations have been reported with smaller frequency. We present a case of an 80 year old man who presented with melena and low hematocrit. Standard investigations (upper/lower GI endoscopy, angiography) failed to locate the bleeding site. Due to hemodynamic instability an explorative laparotomy was performed with intra-operative endoscopy. An ulcer with a visible vessel at its base was found in the jejunum, consistent with Dieulafoy's lesion. Active bleeding was not present at the time. The segment of bowel containing DL was resected and the bowel was anastomosed. Pathology confirmed the diagnosis. The patient was discharged 2 weeks later in good condition.