Case Description
A 48-year-old woman with no comorbidities presented with maroon stools for 3 weeks.
She denied any previous GI bleed, alcohol or smoking consumption, or bleeding disorders.
The patient has not been on nonsteroidal anti-inflammatory drugs, antiplatelets, anticoagulants,
or corticosteroids. Prior esophagogastroduodenoscopies were inconclusive, though colonoscopy
showed blood in the colon and ileum without a source. She required multiple blood
transfusions; her hemoglobin was 40 g/L, white blood cell count was 9.9 × 109/L, platelet count was 302 × 109/L, and serum urea was 16.8 mmol/L. Other laboratory parameters and imaging were unremarkable.
Repeat esophagogastroduodenoscopy was normal, and repeat colonoscopy again revealed
only intraluminal blood. Computed tomography angiography was negative. Capsule endoscopy
localized bleeding to the proximal ileum. Double-balloon enteroscopy (DBE) identified
an actively bleeding large submucosal artery in the proximal ileum, 240 cm from the
gastroduodenal junction, consistent with DL ([Figs. 1] and [2]). Endoscopic hemostasis was achieved with a dual-modality approach—epinephrine injection
(1:10,000 dilution, 2 mL aliquots circumferentially) to reduce active spurting and
improve visualization, followed by deployment of single through-the-scope hemoclip
across the bleeding point to mechanically occlude the vessel ([Fig. 3]). The patient had no recurrence of bleeding, avoided surgery, and remains well at
12-month follow-up.
Fig. 1 Figure showing Dieulafoy's lesion in proximal ileum.
Fig. 2 Figure showing active bleed from the lesion.
Fig. 3 Hemoclip application for hemostasis.
