Two cases of Dieulafoy’s lesion in unusual sites: A rare case reports of gastrointestinal bleeding

Introduction: Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management cha...

Full description

Saved in:
Bibliographic Details
Published in:International journal of surgery case reports 2024-04, Vol.117, p.109562, Article 109562
Main Authors: Zazour, Abdelkrim, Belkhayat, Chifaa, Bennani, Amal, Bouziane, Mohamed, Kharrasse, Ghizlane, Ismaili, Zahi
Format: Article
Language:English
Subjects:
Case Report
Colon
Dieulafoy's lesion
Endoscopy
Gastrointestinal bleeding
Small bowel
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges. Case presentation: In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches. Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery. Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This case was successfully managed through an endoscopic hemostasis approach. Discussion: Dieulafoy's lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy's patients. This lesion is responsible for approximately 1–2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed. Conclusion: DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required. •Dieulafoy's lesion (DL) is a rare vascular malformation that can cause potentially life-threatening bleeding.•DLs located in unusual sites such as the small intestine and colon present a challenge for diagnosis and management.•Endoscopic methods of hemostasis are the first choice for the management of DLs.•In cases of unsuccessful endoscopic hemostasis, surgery or selective arterial embolization may be required.
ISSN:2210-2612
2210-2612
DOI:10.1016/j.ijscr.2024.109562