MASSIVE LOWER GASTROINTESTINAL-BLEEDING DUE TO DIEULAFOYS VASCULAR MALFORMATION OF THE JEJUNUM - CASE-REPORT

Dieulafoy reported three cases of massive gastric hemorrhage due to a dilated submucosal artery in 1898, and since then, more than 100 cases of this gastric vascular malformation have been reported in the liter ature, These same pathologic lesions are even a rarer occurrence in th e small bowel, This article reports a 38-year-old hypotensive male who presented to the hospital after an acute onset of massive lower gastr ointestinal hemorrhage; superior mesenteric angiography demonstrated a n actively bleeding lesion in a proximal jejunal branch, Intraoperativ e small bowel endoscopy via an enterotomy demonstrated a 4 mm bleeding submucosal lesion 30 cm distal to the ligament of Treitz. A literatur e review revealed six other cases of Dieulafoy's vascular malformation that occurred in the small bowel, with the lesions located in the pro ximal jejunum between 15 cm and 45 cm distal to the ligament of Treitz ,The cause of these lesions is unknown. This case demonstrates the imp ortance of preoperative angiography and intraoperative endoscopy when massive lower gastrointestinal hemorrhage is suspected to be from a sm all bowel source.