Minimal Resection of Jejuna Dieulafoy's Lesion Using an Intraoperative Fluoroscopic Localization of the Metallic Coils Used in Angiography

Abstract

Dieulafoy's lesions of the Jejunum are extremely rare. Therefore, localization of lesions is very difficult due to their small size and tendency of occasional bleeding. However, it is important to mention the location of the Dieulafoy's lesions to prevent excessive intestinal resections or, even worse, resection of the normal intestine. We report a case of preoperative localization of a Dieulafoy's lesion embolized by a metallic coil that allows a surgeon to accurately identify the bleeding, permitting a minimally invasive surgical treatment. A 25-year-old man presented with massive hematochezia. There was no definite bleeding focus on the upper gastrointestinal endoscopy and colonoscopy. An angiography found a persistent extravasation of the contrast media at the end of straight artery of the mid-jejunal branch, around the terminal ileum, embolized with metallic coils immediately. The combination of embolized metallic coils and intraoperative fluoroscopy allowed accurate identification and minimal laparotomy. Consequently, a highly selective and minimal resection of the jejunum containing the dieulafoy lesion was possible without any postoperative complications.

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

“…99,100 In our review, transarterial embolization was performed in 5 cases but it failed to secure hemostasis. 41,49,57,101,102 Subsequently, these patients were treated with surgery (n = 4) or endoscopic therapy (n = 1). Factors such as relative jejunal mobility and its wall thinness may disrupt an optimal arterial compression following transarterial embolization, leading to treatment failure.…”

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.…”

Coil-Localized Laparoscopic-Assisted Resection of Symptomatic Gastrointestinal Vascular Malformations in Children and Young Adults

“…For example, intentional preoperative coil placement has been reported in 2 patients with jejunal AVMs ( 6 , 7 ). Coils used as a secondary localization tool at the time of laparoscopy for jejunal Dieulafoy’s lesion and jejunal AVM has also been reported in adults ( 8 , 9 ). In these cases, the primary aim of embolization has been applied to treat acute bleeding; the embolized coils fortuitously became localizing agents when ongoing bleeding prompted operative intervention later.…”