Dieulafoy’s jejunal lesion as a source of lifethreating bleeding

Czech version

Authors: Lenka Dvorská ¹; Jiří Janoušek ¹; Ilja Tachecí ²; Tomáš Rozkoš ³
Authors‘ workplace: 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: Vnitř Lék 2020; 66(6): 381-385
Category: Case Report

Overview

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

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