Recurrent bleeding in a patient with hepaticojejunostomy caused by Dieulafoy's lesion
| Authors | |
|---|---|
| Year of publication | 2023 |
| Type | Article in Periodical |
| Magazine / Source | UNITED EUROPEAN GASTROENTEROLOGY JOURNAL |
| MU Faculty or unit | |
| Citation | |
| Web | https://onlinelibrary.wiley.com/doi/10.1002/ueg2.12440 |
| Doi | http://dx.doi.org/10.1002/ueg2.12440 |
| Keywords | bleeding; Dieulafoy's lesion; endoscopy; enteroscopy; hepaticojejunostomy |
| Description | A 27-year-old woman was referred to our endoscopy center for recurrent upper gastrointestinal bleeding requiring multiple blood transfusions over 4 years. She had undergone common bile duct resection with hepaticojejunostomy and cholecystectomy due to choledochal cyst at age 4. Repeated upper endoscopy, colonoscopy, CT angiography, video capsule endoscopy (VCE), magnetic resonance cholangiopancreatography, and scintigraphy were negative. Cap-assisted motorized spiral enteroscopy was performed and Y-Roux-en afferent loop with hepaticojejunostomy was reached (Figure 1). Just below the anastomotic line was a diminutive ulceration with prominent pulsating vessel (Figure 2). When touched by the cap, the ulceration immediately began to spurt blood (Figure 3). Treatment was by argon plasma coagulation (APC), endoclips, and inserting a double pig-tail 7 French stent (Figure 4). The biliary plastic stent was placed to avoid a possible stenosis in the anastomosis after the use of APC and application of endoclips near the anastomosis. At 3 month follow-up of enteroscopy, the stent was removed. The patient is being followed up and has shown no signs of ongoing bleeding. |