Bleeding Dieulafoy's-like lesions of the gut identified by capsule endoscopy

Abstract

Dieulafoy's-like lesions (DLs-like) represent a cause of obscure gastrointestinal bleeding, enteroscopy being the main diagnostic and therapeutic procedure. Frequently, more than one enteroscopy is needed to identify the bleeding vessel. In our practice, video capsule endoscopy (VCE) identified and guided therapy in four cases of DLs-like; three of them were localized on the small bowel. We report, for the first time, a diagnosis of colonic DL-like performed by colon capsule endoscopy. Two patients presented with severe cardiovascular disorders, being hemodynamically unstable during VCE examination. Based on the VCE findings, only one invasive therapeutic procedure per patient was necessary to achieve hemostasis. VCE and enteroscopy may be regarded as complementary procedures in patients with gut DLs-like.

Keywords: Dieulafoy’s-like lesion; Enteroscopy; Obscure gastrointestinal bleeding; Small bowel; Video capsule endoscopy.

Figure 1

Capsule endoscopy. A: Significant amounts of fresh blood in the first jejunal loop; B: A very small mucosal break suggestive of Dieulafoy’s lesion in the jejunum (circle); C: A bleeding mucosal break on the colonic mucosa; D: A small mucosal break in the proximal jejunum (circle).