Treatment of ileal Dieulafoy's lesion by hemostatic clips under double-balloon enteroscopy: a case report.

Abstract

Background: Small intestinal Dieulafoy's lesion (DL) is a rare cause of life-threatening gastrointestinal bleeding. Based on previous case reports, the diagnostic approaches for DL located in jejunum and ileum are different. In addition, there is no available consensus regarding the treatment of DL, and previous case reports suggest that surgery is the preferable choice for small intestinal DL compared to endoscopic treatment. Notably, our case report indicates that double-balloon enteroscopy (DBE) should be an effective diagnostic and therapeutic approach for small intestinal DL.

Case description: A 66-year-old female was transferred to the Department of Gastroenterology due to hematochezia and abdominal distension and pain for more than 10 days. She had a history of diabetes, hypertension, coronary heart disease, atrial fibrillation, mitral insufficiency, and acute cerebral infarction. Conventional diagnostic approaches, including gastroduodenoscopy, colonoscopy, and even angiogram, did not show any definite source of bleeding, and then a capsule endoscopy was performed and suggested that the bleeding may be located in ileum. Finally, she was successfully treated by hemostatic clips under DBE via anal route. And there is no recurrence after endoscopic treatment was observed in our case during a 4-month follow-up.

Conclusions: Although small intestinal DL is rare and difficult to be detected by conventional approaches, DL still needs to be considered as a differential diagnosis for gastrointestinal bleeding. In addition, DBE should be considered as a preferred choice for the diagnosis and treatment of small intestinal DL due to lower invasiveness and cost as compared to surgery.