Sudden-onset gastrointestinal bleeding in a young adult: diagnostic and therapeutic challenges of a Dieulafoy's lesion in the jejunum.

Abstract

Background: A Dieulafoy's lesion in the jejunum is at an uncommon site but may be the cause of massive gastrointestinal bleeding. It is characterized by a large, tortuous submucosal artery that erodes the overlying epithelium and presents diagnostic and therapeutic challenges due to its atypical location and presentation.

Case: A 30-year-old male presented with sudden onset syncope and the passage of 200-300 ml of red blood-mixed stool. With no major comorbidities, he had hypotension with a blood pressure of 80/50 mmHg, necessitating immediate transfusion of three units of packed red blood cells (PRBCs). Initial endoscopic evaluations, including an UGI endoscopy and colonoscopy, failed to locate the bleeding source. CT angiography identified an active bleed from the first jejunal branch leading to coil embolization. Persistent symptoms prompted capsule endoscopy, revealing angioectasia in the proximal jejunum. Despite haemoclip application and a total of 11 units of blood transfused, his symptoms persisted. He then underwent laparoscopic resection of the jejunal segment containing the polyp, followed by extracorporeal jejuno-jejunal anastomosis. Histopathology confirmed a benign polyp with central ulceration, consistent with a Dieulafoy's lesion.

Conclusions: Advanced diagnostic techniques like CT angiography and capsule endoscopy played a pivotal role in localizing the bleeding source. Surgical intervention proved curative when less invasive methods failed. The patient's postoperative course was uneventful, highlighting the efficacy of a multidisciplinary approach. A high index of suspicion and a multidisciplinary approach are essential for successful outcomes.