Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Aug 15, 2016; 7(3): 296-299
Published online Aug 15, 2016. doi: 10.4291/wjgp.v7.i3.296
Culprit for recurrent acute gastrointestinal massive bleeding: “Small bowel Dieulafoy’s lesions” - a case report and literature review
Anjana Sathyamurthy, Jessica N Winn, Jamal A Ibdah, Veysel Tahan
Anjana Sathyamurthy, Jessica N Winn, Jamal A Ibdah, Veysel Tahan, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65201, United States
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Institutional review board statement: This case report was approved by the Institutional Review Board of University of Missouri-Columbia. IRB #2004644.
Informed consent statement: The patient was consented and we got our institutional Review Board approval at University of Missouri-Columbia.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Veysel Tahan, MD, Assistant Professor, Division of Gastroenterology and Hepatology, University of Missouri, 1 Hospital Dr, Columbia, MO 65201, United States. tahanv@health.missouri.edu
Telephone: +1-573-8846044 Fax: +1-573-8844595
Received: March 24, 2016
Peer-review started: March 24, 2016
First decision: May 16, 2016
Revised: June 2, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: August 15, 2016
Processing time: 140 Days and 3.7 Hours
Abstract

A Dieulafoy's lesion is a dilated, aberrant, submucosal vessel that erodes the overlying epithelium without evidence of a primary ulcer or erosion. It can be located anywhere in the gastrointestinal tract. We describe a case of massive gastrointestinal bleeding from Dieulafoy’s lesions in the duodenum. Etiology and precipitating events of a Dieulafoy’s lesion are not well known. Bleeding can range from being self-limited to massive life- threatening. Endoscopic hemostasis can be achieved with a combination of therapeutic modalities. The endoscopic management includes sclerosant injection, heater probe, laser therapy, electrocautery, cyanoacrylate glue, banding, and clipping. Endoscopic tattooing can be helpful to locate the lesion for further endoscopic re-treatment or intraoperative wedge resection. Therapeutic options for re-bleeding lesions comprise of repeated endoscopic hemostasis, angiographic embolization or surgical wedge resection of the lesions. We present a 63-year-old Caucasian male with active bleeding from the two small bowel Dieulafoy’s lesions, which was successfully controlled with epinephrine injection and clip applications.

Keywords: Dieulafoy’s lesion; Small intestine; Massive bleeding; Endoscopic treatment; Endoscopy; Surgery

Core tip: Small bowel Dieulafoy’s lesion is a rare entity that can cause severe life threatening gastrointestinal hemorrhage. It is difficult to diagnose and treat a small bowel Dieulafoy’s lesion by initial endoscopy unlike most gastric Dieulafoy’s lesions. We report a rare presentation of small bowel Dieulafoy’s lesions in a 63-year-old male. The hemorrhage was successfully controlled by epinephrine injection and clip applications. We also reviewed small bowel Dieulafoy’s lesion studies and reports in the literature.