Abstract
BackgroundDieulafoy lesion, also known as calibre persistent artery is a rare cause of massive GI bleeding. It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm). Commonest location is in proximal stomach while occurrence in small intestine, especially ileum is extremely rare.Case presentationA 26 year old female presented with lower gastrointestinal bleeding. Preliminary investigations failed to locate the exact source of bleed. At laparotomy, an ulcerated nodular lesion, approximately 0.8 cm in diameter was identified in distal ileum. Histology revealed it to be Dieulafoy lesion.ConclusionAlthough uncommon, ileal dieulafoy is one of the causes of obscure gastrointestinal bleeding that could result in treacherous and life-threatening gastrointestinal haemorrhage. Hence, it should be considered in the differential diagnosis of active GI bleeding. The definitive diagnosis is based only on histopathology.
Highlights
Dieulafoy lesion, known as calibre persistent artery is a rare cause of massive GI bleeding
It’s an abnormal sub-mucosal artery protruding from a minute mucosal defect (≤3 mm) with normal surrounding mucosa or active arterial bleeding without an ulcer base (Gustavo, 2008)
Dieulafoy lesion (DL) are located in proximal stomach in more than three-quarters of affected patients and occurrence in intestine is extremely rare (Christopher Ma & Edwin, 2014; Gustavo, 2008; Shibutani et al, 2011)
Summary
Ileal DL can cause life-threatening hemorrhage and should be considered in differential diagnosis of GI bleeding. An aggressive multidisciplinary approach including radiologic intervention, enteroscopy and surgery is required for proper diagnosis and treatment
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