Dieulafoy’s jejunal lesion as a source of lifethreating bleeding

Česká verzia

Authors: Lenka Dvorská ¹; Jiří Janoušek ¹; Ilja Tachecí ²; Tomáš Rozkoš ³
Authors place of work: Interní oddělení Oblastní nemocnice Trutnov, a. s. ¹; II. interní gastroenterologická klinika LF UK a FN Hradec Králové ²; Fingerlandův ústav patologie LF UK a FN Hradec Králové ³
Published in the journal: Vnitř Lék 2020; 66(6): 381-385
Category: Case Report

Summary

Dieulafoy`s lesion is a rare condition characterized by bleeding into gastrointestinal tract from minimaly eroded submucous artery. Mostly is localized in stomach in elderly polymorbid men, but can occure in entire gastrointestinal tract, in both sexes, in every age. It should be thought off as one of possible causes of obscure bleeding. It is often massive, requiring fast diagnostics, treatment and multidisciplinary approach. The case report discusses patient with recurrent hemodynamicaly significant bleeding into jejunum. It pointed to combined diagnostic approach using both endoscopy and angiography. After failing endoscopically and angiografically due to hemodynamic instability, surgical intervention took place. Precise Dieulafoy`s lesion diagnosis has been determined eventually on histologic section. Diagnostic and therapeutic approach should be individual taking patient´s condition and capabilities of department into consideration. Surgical intervention remains golden standard when hemodynamic instability occures or when endoscopy and angiography fail.

Keywords:

Jejunum – acute gastrointestinal bleeding – Dieulafoy’s lesion – obscure bleeding

Zdroje

1. Lukáš K, Hoch J, et al. Nemoci střev. Praha: Grada 2018, 292 s.

2. Baxter M, Aly EH. Dieulafoy’s lesion: Current trends in diagnosis and management. Ann R Coll Surg Engl 2010; 92: 548–554.

3. Nojkov B, Cappel MS. Gastrointestinal bleeding from Dielafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy. World J Gastrointest Endosc 2015; 7: 295–307.

4. Parrot A, Antoine M, Khalil A, et al. Aproach to diagnosis and pathological examination in bronchial Dieulafoy disease: a case series. Resp Res 2008; 9: 58.

5. Yilmaz T, Kozan R. Duodenal and jejunal Dieulafoy’s lesions: optimal managment. Clinical and Experimental Gastroenterology 2017; 10: 275–283.

6. Zavras N, et al. Succesful diagnosis and treatment of Dieulafoy’s lesion with endoscopy and termocoagulation in full‑term neonate: Report of a case and literature review. J Ped Surg Case Reports 2014; 2: 250–253.

7. Chao H, et al. Jejunal Dieulafoy lesion detected by intraoperative endoscopy in a child. Iran J Pediatr 2016; 26: e7727.

8. Kozan R, Gulen M, Yilmaz TU, et al. Massive lower gastrointestinal bleeding from a jejunal Dieulafoy lesion. Ulus Cerrahi Derg 2014; 30: 225–227.

9. http://www.endoskopiste.cz/wp ‑content/uploads/2016/06/komentar ‑ke ‑guidelines‑asge ‑krvaceni ‑z‑neurceneho ‑zdroje.pdf

10. Tacheci I, Devière J, Kopacova M, et al. The importance of upper gastrointestinal lesions detected with capsule endoscopy in patients with obscure digestive bleeding. Acta Gastroenterol Belg 2011; 74: 395–399.

11. Pennazio M, et al. Small ‑bowel capsule endoscopy and device ‑assisted enteroscopy for diagnosis and treatment of small ‑bowel disorders: European Society of Gastro‑ intestinal Endoscopy (ESGE) Clinical Guideline 2015; 47: 352–376.

12. Aomatsu N, et al. A case of emergency resection of a giant gastrointestinal stromal tumor of the stomach associated with hemorrhagic shock. Gan To Kagaku Ryoho 2013; 40: 2185–2187.

13. Lipka S, Rabbanifard R, Kumar A, et al. A single ‑center United States experience with bleeding Dieulafoy lesions of the small bowel: diagnosis and treatment with single ‑balloon enteroscopy. Endosc Int Open 2015; 3: 339–345.

14. Dulic ‑Lakovic E, et al. Bleeding Dieulafoy lesions of the small bowel: a systematic study on the epidemiology and efficacy of enteroskopic treatment. Gastrointest Endosc 2011; 74: 573–580.

15. Adamová Z, Slováček R. Diagnostika a léčba krvácení do dolní části zažívacího traktu. Med praxi 2013; 10: 380–382.

16. Kim JK, Jo BJ, Lee KM, et al. Dieulafoy’s lesion of jejunum: presenting small bowel mass and stricture. Yonsei Med J 2005; 46: 445–447.

17. Alshumrani G, Almuaikeel M. Angiographic findings and endovascular embolization in Dieulafoy disease: a case report and literature review. Diagn Interv Radiol 2006; 12: 151–154.