Jejunal Dieulafoy Lesion Detected by Intraoperative Endoscopy in a Child

Abstract

Introduction: Dieulafoy lesion is an unusual cause of gastrointestinal bleeding in which significant, and often recurrent, hemorrhage occurs from a pinpoint non-ulcerated arterial lesion. It is usually located in gastric fundus, and is extremely rare in children. Case Presentation: In this study, we present a male adolescent with jejunal Dieulafoy lesion. The patient was admitted to the hospital due to hematochezia and hypotension. No active bleeders were identified on endoscopy, colonoscopy, and double-balloon enteroscopy. Computed tomography angiography revealed active bleeders in jejunum. An intraoperative enteroscopy, using flexible endoscopy, revealed a jejunal Dieulafoy lesion with spurting bleeding. The patient was successfully treated by bowel resection. Conclusions: Intraoperative endoscopy is a relatively efficient and safe modality for evaluating the bleeding Dieulafoy lesion in the small intestine, and is essential for directing surgery.

Jejunal Dieulafoy’s Lesion: A Systematic Review of Evaluation, Diagnosis, and Management

“…During surgery, intraoperative enteroscopy can be performed to help localize the bleeder. 70 The findings of this review showed that the single-and double-balloon enteroscopies were the ideal techniques, with the diagnostic yields of 96% and 98%, respectively. These device-assisted enteroscopies are more efficacious in identifying Dieulafoy's lesion as they complement noninvasive techniques like capsule endoscopy.…”

Open Surgery with Intraoperative Enteroscopy in Jejunoileal Massive Bleeding in Pediatric Patient: An Evidence-Based Case Report

“…All of the patients had no recurrence after the surgery. 11,12,13,14,15,16 This report shows that all of the articles have no recurrence after surgery, even though the surgery is done laparoscopically.…”

“…Six articles combined open surgery with intraoperative enteroscopy, and others with laparoscopic surgery in combination with enteroscopy, super-selective angiography, and embolization, and laparotomy RA alone with preoperative angiography. 11,12,13,14,15,16…”

A Multidisciplinary approach to treat massive recurrent hematochezia from a jejunal Dieulafoy lesion: A case report

“…In most of these cases, DLs were detected by multiple modalities, some of which were repeated in various attempts in some cases, and tailored combinations of measures were performed to control the bleeding. [12][13][14][15][16][17][18][19][20][21][22][23] In conclusion, jejunal DLs presenting with untypical manifestations should not be ignored when they cause episodes of sudden, recurrent, and massive GI bleeding. Bleeding events may be triggered after gastroenteritis.…”