A case of Dieulafoy's lesion of the small intestine treated successfully by endoscopic hemostasis

A 23-year-old man was presented to the emergency room with bloody stools. His vital signs were stable on admission, but a blood test showed anemia (hemoglobin 10.9 g/dL). Contrast-enhanced computed tomography showed no obvious extravasation, and the source of bleeding was unclear. Esophagogastroduodenoscopy and colonoscopy were performed, but the source of bleeding could not be identified. Capsule endoscopy was performed on the day 4 of illness, and bloody stools recurred. Bleeding was observed in the small intestine on the monitor, suggesting it was the site of bleeding. Enteroscopy was performed immediately, which revealed bleeding from Dieulafoy's lesion. Hemostasis was performed with an endoscopic clip. Thereafter, no recurrence of hematochezia was observed, and the patient was discharged on day 11. Dieulafoy's lesion of the small intestine is very rare, and there are few reports of cases in which hemostasis was achieved endoscopically. Here we describe this case of small intestinal Dieulafoy's lesion in which hemostasis was achieved by enteroscopy performed immediately after confirmation of active bleeding and identification of the bleeding site on the capsule endoscope monitor.