Recurrent bleeding in a patient with hepaticojejunostomy caused by Dieulafoy's lesion

FALT, Premysl and Lumír KUNOVSKÝ. Recurrent bleeding in a patient with hepaticojejunostomy caused by Dieulafoy's lesion. UNITED EUROPEAN GASTROENTEROLOGY JOURNAL. ENGLAND: JOHN WILEY & SONS LTD, 2023, vol. 11, No 9, p. 904-905. ISSN 2050-6406. Available from: https://dx.doi.org/10.1002/ueg2.12440.

Basic information

• Original name: Recurrent bleeding in a patient with hepaticojejunostomy caused by Dieulafoy's lesion
• Authors: FALT, Premysl (203 Czech Republic) and Lumír KUNOVSKÝ (203 Czech Republic, guarantor, belonging to the institution).
• Edition: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL, ENGLAND, JOHN WILEY & SONS LTD, 2023, 2050-6406.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30219 Gastroenterology and hepatology
• Country of publisher: United Kingdom of Great Britain and Northern Ireland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 6.000 in 2022
• RIV identification code: RIV/00216224:14110/23:00131596
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1002/ueg2.12440
• UT WoS: 001034053400001
• Keywords in English: bleeding; Dieulafoy's lesion; endoscopy; enteroscopy; hepaticojejunostomy
• Tags: 14110223, rivok
• Tags: International impact, Reviewed

Abstract

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.