Massive jejunal hemorrhage secondary to Dieulafoy's lesion in a young male with congenital urogenital anomalies: a rare case report.

Introduction and importance: Dieulafoy's lesion (DL) is a rare but potentially life-threatening vascular anomaly that can cause severe gastrointestinal (GI) bleeding. While it most commonly occurs in the stomach, jejunal involvement is exceedingly rare and poses significant diagnostic challenges. Presentation of case: We report a 25-year-old male with a history of congenital urogenital anomalies who presented with melena and hematochezia for 7 days. Initial endoscopic and imaging studies failed to identify the bleeding source. Owing to hemodynamic instability and diagnostic limitations, the patient underwent emergency exploratory laparotomy, which revealed a massively hemorrhagic jejunal DL. Segmental jejunal resection with primary anastomosis resulted in complete recovery. Clinical discussion: DL accounts for 1%-2% of GI hemorrhages and is often associated with non-steroidal anti-inflammatory drugs use and comorbidities. Diagnosis of jejunal DL is challenging due to its rarity and inaccessibility via routine endoscopy. While endoscopic and angiographic interventions are preferred, surgical management remains definitive in unstable patients or when noninvasive techniques fail. Conclusion: Jejunal DL should be considered in unexplained GI bleeding when conventional diagnostics are inconclusive. Early multidisciplinary management and timely surgical intervention can significantly improve outcomes.