Exsanguinating jejunal Dieulafoy's hemorrhage: how failed embolization guided life-saving resection - a case report.

Introduction and importance: Dieulafoy's lesion is a rare but severe cause of gastrointestinal bleeding. It is characterized by an aberrant submucosal arteriole eroding through the gastrointestinal mucosa, typically causing sudden, painless, and massive gastrointestinal hemorrhage that may present with intermittent, recurrent bleeding episodes. We report a case of hemorrhagic shock secondary to massive gastrointestinal bleeding caused by a jejunal Dieulafoy's lesion. Case presentation: A 31-year-old female without significant medical comorbidities acutely developed recurrent, high-volume hematochezia and hypotensive shock. She was hemodynamically unstable with a hemoglobin level of 35 g/l upon admission. After hemodynamic stabilization and transfusion, endoscopy failed to localize the bleeding source, which was later identified in the jejunum by angiography. Selective arterial embolization was implemented but failed to achieve hemostasis. Consequently, exploratory laparotomy with segmental jejunal resection of the Dieulafoy's lesion was performed. The patient demonstrated satisfactory recovery and was discharged on the fifth postoperative day. Clinical discussion: Jejunal Dieulafoy's lesion is an exceedingly rare cause of gastrointestinal bleeding, accounting for merely 1% of all Dieulafoy's lesions. Diagnosis is challenging due to the inaccessibility of jejunum with conventional endoscopy and the intermittent nature of hemorrhage. Angiographic embolization is effective for active bleeding when endoscopic therapy fails. Surgery remains an option when other interventions are unsuccessful, particularly in hemodynamically unstable patients. Conclusion: Jejunal Dieulafoy's lesion, though rare, is a potentially life-threatening cause of gastrointestinal hemorrhage that demands prompt diagnosis and intervention. A multidisciplinary approach - combining endoscopic therapy, angiography, and surgery - significantly enhances clinical outcomes.