LAUSR

Dieulafoy’s lesion is an extremely rare condition characterized by a large aberrant submucosal vessel that may protrude through a defect of the overlying mucosa without primary mucosal ulceration. We present the first case described in the literature of ileal Dieulafoy’s lesion associated with Crohn’s disease as a cause of lower gastrointestinal bleeding. A 46-year-old male presented with lower gastrointestinal bleeding. He had a history of previous subtotal colectomy with ileosigmoid anastomosis due to refractory fistulizing and stricturing Crohn’s disease and posterior lower gastrointestinal bleeding secondary to a red vessel surrounded by a small ulceration in the terminal ileum that required endoscopic management. A colonoscopy showed unspecific ileitis and colitis findings in the perianastomotic region. Computed tomography-angiography revealed a tortuous ileal artery secondary to a fibrous tract entrapment (Fig. 1). An end ileostomy with previous ileosigmoid anastomosis resection was performed. A massive mesenteric thickening and hypervascularization associated with fibrosis and retraction of the ileal segment were identified. Pathological examination showed large-calibre submucosal arteries in the resected ileum suggesting Dieulafoy’s lesion (Fig. 2). He was discharged on the 10th postoperative day and presented no re-bleeding at 6-month follow-up.