Massive Gastrointestinal Bleeding from a Jejunal Dieulafoy Lesion: An Extraordinary Presentation

Abstract

We present an atypical and rare case of a previously healthy 27-year-old male who presented with acute onset of abdominal pain, bloody diarrhea, and syncope. At the Emergency Department, vital signs were stable with no signs of shock. Physical examination revealed diffuse tenderness of the abdomen and cherry red blood was noted upon rectal examination. Blood tests showed marked leukocytosis without anemia. Sigmoidoscopy was performed which revealed hematochezia with no obvious site of bleeding. The patient was admitted to the hospital with a working diagnosis of dysentery and received supportive care. During the following days, blood tests revealed an ongoing decline of hemoglobin levels which necessitated a new workup of gastrointestinal bleeding. Investigation modalities including upper and lower endoscopies as well as angiography failed to demonstrate a bleeding site. Scintigraphy, which was performed next, demonstrated an increased radiotracer activity in the right abdomen consistent with small bowel bleeding. Following these results, the patient underwent urgent laparotomy and surgical resection was performed. The histopathological findings were consistent with a Dieulafoy lesion. This case illustrates the importance of the complementary role of various modalities in locating the bleeding site along the gastrointestinal tract.

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

“…[34][35][36][37] Patients often present with melena (33%), obscure-overt gastrointestinal bleeding (29%), or hematochezia (13%) (Table 2). [38][39][40][41][42][43][44] The bleeding can be particularly severe and intermittent due to the vessel's large diameter and pulsatile nature (Figure 4). 45,46 Therefore, hemodynamic compromise may also ensue in approximately 20% of patients, culminating in tachycardia, hypotension, and even hypovolemic syncope.…”

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.…”

Dieulafoy Lesion as a Source of Bleeding: A Report of Two Clinical Cases

“…In case of unsuccessful endoscopic hemostasis, transcatheter angiographic embolization or surgical lesion is considered [19], according to the recommendations of the European Society of Gastrointestinal Endoscopy [20].…”