Dieulafoy’s Lesion of the Ileum: Diagnostic Challenges and Surgical Management

Dieulafoy's lesion is a rare cause of gastrointestinal hemorrhage characterized by submucosal arterial dilation without inflammatory changes. Ileal localization is exceptionally uncommon and poses significant diagnostic challenges. We report a case of a 50-year-old male patient who presented with upper gastrointestinal bleeding manifested by hematemesis and melena. Upper gastrointestinal endoscopy and colonoscopy failed to identify the bleeding source. Computed tomography angiography revealed a hyperdense nodular formation in the ileum. An exploratory laparotomy with bowel resection and end-to-end anastomosis was performed. Histopathological examination confirmed the diagnosis of Dieulafoy's lesion of the ileum. The patient was discharged on the third postoperative day with uneventful recovery and remained in good health at four-week follow-up. This case illustrates that an ileal Dieulafoy's lesion should be considered in the differential diagnosis of obscure gastrointestinal bleeding when endoscopic evaluation is inconclusive. Although enteroscopy or capsule endoscopy may aid in diagnosis, surgery remains the definitive diagnostic and therapeutic intervention in regions where these facilities are not available.