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Abstract

 
 
 
 Dieulafoy lesion is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). A 31 yearold male presented with complaints of hematochezia. Preliminary investigations failed to locate the exact source of bleed. Enteroscopy suggested distal ileal bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.5 cm was identified in distal ileum. 30 cm of ileum along with mesentery was resected. Histology revealed it to be Dieulafoy lesion. Dieulafoy lesion is uncommon but one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. This lesion is difficult to identify and high index of suspicion is required to make diagnosis. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.
 
 
 
Highlights
Dieulafoy lesion (DL), called calibre persistent artery/ submucosal arterial malformation, is a rare cause of massive GI bleed (0.3–6%)[1]
Exploratory laparotomy was done and intra-operatively, distal ileum was cut along the anti-mesenteric border to localize the bleeding source
Because the artery reaches close to the muscularis mucosae in Dieulafoy disease, such fibers hold the artery to the muscularis mucosae as well
Summary
Dieulafoy lesion (DL), called calibre persistent artery/ submucosal arterial malformation, is a rare cause of massive GI bleed (0.3–6%)[1]. We report a rare case of lower GI bleed secondary to an ileal Dielulafoy lesion in a young male. Colonoscopy revealed blood clots within the bowel, with no obvious bleeding source. Enteroscopy revealed blood clots in distal ileum.
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