Two Cases of Ileal Dieulafoy Lesion with Massive Hematochezia Treated by Single Balloon Enteroscopy
A 79-year-old woman was admitted due to hematochezia and dizziness. She had obstructive coronary artery disease and took aspirin and an antiplatelet agent. On admission, blood pressure was 127/75 mm Hg, and pulse was 102 beats/min. Blood hemoglobin level was 8.7 g/dL. On the day of admission, she underwent EGD and colonoscopy, but we could not find the bleeding focus. She then underwent abdominal CT, but there was no specific lesion in the GI tract suspicious for bleeding. We recommended enteroscopy for evaluation of the obscure bleeding focus, but she refused because her melena ceased. Vital signs were stabilized, and she was discharged home on the ninth admission day. Six days after discharge, she revisited our hospital due to recurrent fresh hematochezia. At that time, blood pressure dropped to 88/56 mm Hg, and pulse was 107 beats/min. Blood hemoglobin level was 8.3 g/dL. As she had underwent EGD and colonoscopy, we performed SBE with a retrograde approach. We found a fresh blood clot adherent on the mucosa of proximal ileum and, after saline irrigation, we detected the active bleeding focus at a narrow point of normal-appearing mucosa (). Hemostasis was successfully done using hemoclips (). She was discharged home and had no evidence of recurrent GI bleeding at her 2 month follow-up visit.