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dc.contributor.authorPatel, Bhavik
dc.contributor.authorJeenah, Natasha R
dc.contributor.authorCanavan, Russell
dc.contributor.authorWullschleger, Martin
dc.description.abstractA 64‐year‐old male patient was admitted to our level 1 trauma centre following a high‐speed motorbike crash with thoracic spine, abdominal, bilateral upper and lower extremities injuries. On admission, the trauma series computed tomography (CT) scan did not suggest any acute bowel pathology; however, 24 hours later whilst in theatre for re‐washout of the lower extremity wound and increasing ionotropic requirement, we decided to do a laparotomy. Intraoperative findings were suggestive of ischaemic necrosis of the colon and majority of small bowel. He underwent a subtotal colectomy, along with small bowel resection – the proximal jejunum (100 cm from duodeno‐jejunal junction) and most of the ileum, sparing 20 cm of distal ileum. After 24 hours, as physiology improved, re‐look laparotomy with hand‐sewn jejuno‐ileal anastomosis and end ileostomy was carried out. Histology suggested gangrenous infarction and wall necrosis, and no evidence of embolus or thrombus. Post‐operatively, on day 21, he developed selective trans‐stomal bleeding requiring blood products to maintain haemodynamic stability. Further resection of small bowel was not an option as the patient and the next of kin declined surgery due to reluctance of being on lifelong total parenteral nutrition. Upper gastrointestinal (GI) endoscopy was negative and CT with angiography and delayed venous phase suggested extravasation of contrast (Fig. 1). Interventional radiology managed this with selective coils to the bleeding vessel to avoid ischaemia of the small bowel segment. Unfortunately, 48 h later, he developed further bleeding. At this time, we proceeded to trans‐stomal enteroscopy where a Dieulafoy's lesion (DL) was found 50 cm from the stoma (Fig. 2). Two clips were successfully placed over the DL, no further bleeds were noted and his haemodynamics improved (Fig. 3).
dc.relation.ispartofjournalANZ Journal of Surgery
dc.subject.fieldofresearchClinical Sciences
dc.titleTrans-ileostomy management to Dieulafoy's lesion
dc.typeJournal article
dc.type.descriptionC2 - Articles (Other)
dcterms.bibliographicCitationPatel, B; Jeenah, NR; Canavan, R; Wullschleger, M, Trans-ileostomy management to Dieulafoy's lesion., ANZ Journal of Surgery, 2019
gro.description.notepublicThis publication has been entered into Griffith Research Online as an Advanced Online Version
gro.hasfulltextNo Full Text
gro.griffith.authorWullschleger, Martin

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