Occult gastrointestinal bleeding due to a Dieulafoy lesion in the terminal ileum
Wegdam, J.A.; Hofker, H.S.; Dijkstra, G.; Stolk, M.F.J.; Jacobs, M.A.J.M.; Suurmeijer, A.J.H.
Nederlands Tijdschrift Voor Geneeskunde 150(32): 1776-1779
2006
ISSN/ISBN: 0028-2162 PMID: 16948240 Document Number: 597307
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.