[Occult gastrointestinal bleeding due to a Dieulafoy lesion in the terminal ileum].
A 50-year-old man awaiting liver transplantation for primary sclerosing cholangitis developed iron-deficiency anaemia. Repeated occult gastrointestinal bleeding led to an increasing need for blood transfusions. After multiple oesophagogastroduodenoscopies and colonoscopies, videocapsule endoscopy finally demonstrated a polyp-like lesion in the terminal ileum. The lesion had not been detected despite two attempts (oral and anal) at double-balloon enteroscopy and even a peroperative enteroscopy. Only during a second laparotomy, again involving peroperative enteroscopy, a small red lesion was detected and resected 80 cm proximal to the ileocecal valve (Bauhin's valve). Histology revealed a Dieulafoy lesion. Four months later, after normalisation and stabilisation of his haemoglobin level, the patient received a successful liver transplant. If the cause of occult gastrointestinal bleeding in a patient remains unclear despite regular endoscopic procedures, new techniques like videocapsule endoscopy and double-balloon enteroscopy may contribute to identifying the cause. This may lead to an exceptional finding such as a Dieulafoy lesion in the distal ileum.
Wegdam
J A
JA
Afd. Abdominale Chirurgie, Transplantatie en Orgaandonatie, Universitair Medisch Centrum Groningen, Groningen. j.wegdam@znb.nl
Hofker
H S
HS
Dijkstra
G
G
Stolk
M F J
MF
Jacobs
M A J M
MA
Suurmeijer
A J H
AJ
D018798:Anemia, Iron-Deficiency / Q000209:etiology; D003937:Diagnosis, Differential; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007082:Ileum / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014741:Video Recording