Korean J Gastroenterol.  2017 Feb;69(2):135-138. 10.4166/kjg.2017.69.2.135.

Minimal Resection of Jejuna Dieulafoy's Lesion Using an Intraoperative Fluoroscopic Localization of the Metallic Coils Used in Angiography

• Seo KI
• Moon W
• Lee CW
• Park SJ
• Park MI
• Kim SE
• Kim JH
• Yoon KY
• Chang HK

• KMID: 2383423
• DOI: http://doi.org/10.4166/kjg.2017.69.2.135

Abstract

Dieulafoy's lesions of the Jejunum are extremely rare. Therefore, localization of lesions is very difficult due to their small size and tendency of occasional bleeding. However, it is important to mention the location of the Dieulafoy's lesions to prevent excessive intestinal resections or, even worse, resection of the normal intestine. We report a case of preoperative localization of a Dieulafoy's lesion embolized by a metallic coil that allows a surgeon to accurately identify the bleeding, permitting a minimally invasive surgical treatment. A 25-year-old man presented with massive hematochezia. There was no definite bleeding focus on the upper gastrointestinal endoscopy and colonoscopy. An angiography found a persistent extravasation of the contrast media at the end of straight artery of the mid-jejunal branch, around the terminal ileum, embolized with metallic coils immediately. The combination of embolized metallic coils and intraoperative fluoroscopy allowed accurate identification and minimal laparotomy. Consequently, a highly selective and minimal resection of the jejunum containing the dieulafoy lesion was possible without any postoperative complications.

Keyword

Jejunum; Dieulafoy; Coil; Embolization; Laparotomy

MeSH Terms

Adult
Angiography*
Arteries
Colonoscopy
Contrast Media
Endoscopy, Gastrointestinal
Fluoroscopy
Gastrointestinal Hemorrhage
Hemorrhage
Humans
Ileum
Intestines
Jejunum
Laparotomy
Postoperative Complications
Contrast Media

Figure

• 

  Fig. 1. (A) The superior mesenteric angiogram shows an aneurysmal dilation of the jejunal artery branch in the left upper quadrant. (B) Non-en-hanced CT scan was performed immediately after transcutaneous arterial embolization to exclude the possibility of bleeding tumor. There is a radiopaque density in the jejunum due to glue accumulation, but no definite tumor was identified. (C) Wireless capsule endoscopy showed a 0.5-cm red spot in the proximal jejunum. CT, computed tomography.

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  Fig. 2. (A) After confirmation of a re-bleed from the same site, a second embolization was performed with two metal coils. (B) Localization of the lesion through the detection of the recent embolic material under fluoroscopy. (C) A mass lesion responsible for the current bleeding was successfully removed by minilaparotomy.

• 

  Fig. 3. (A) Gross examination of the resected jejunum showed a 1.3-cm, polypoid, intraluminal lesion. (B) Microscopic examination revealed a polypoid vascular malformation that was predominantly composed of capillaries (H&E, ×100).

Reference

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