Supplementary Material for: Massive Gastrointestinal Bleeding from a Jejunal Dieulafoy Lesion: An Extraordinary Presentation

We present an atypical and rare case of a previously healthy 27-year-old male who presented with acute onset of abdominal pain, bloody diarrhea, and syncope. At the Emergency Department, vital signs were stable with no signs of shock. Physical examination revealed diffuse tenderness of the abdomen and cherry red blood was noted upon rectal examination. Blood tests showed marked leukocytosis without anemia. Sigmoidoscopy was performed which revealed hematochezia with no obvious site of bleeding. The patient was admitted to the hospital with a working diagnosis of dysentery and received supportive care. During the following days, blood tests revealed an ongoing decline of hemoglobin levels which necessitated a new workup of gastrointestinal bleeding. Investigation modalities including upper and lower endoscopies as well as angiography failed to demonstrate a bleeding site. Scintigraphy, which was performed next, demonstrated an increased radiotracer activity in the right abdomen consistent with small bowel bleeding. Following these results, the patient underwent urgent laparotomy and surgical resection was performed. The histopathological findings were consistent with a Dieulafoy lesion. This case illustrates the importance of the complementary role of various modalities in locating the bleeding site along the gastrointestinal tract.本研究报告1例非典型罕见病例：既往体健的27岁男性患者，急性起病，表现为腹痛、血性腹泻及晕厥。患者于急诊就诊时生命体征平稳，无休克征象。体格检查示腹部弥漫性压痛，直肠指检可见樱桃红色血性分泌物。血常规检查提示显著白细胞增多，但无贫血表现。行乙状结肠镜检查，结果提示便血，但未发现明确出血灶。患者以细菌性痢疾初步诊断收入院，接受支持治疗。后续复查血常规可见血红蛋白水平持续下降，因此需重新开展消化道出血相关排查。随后完善胃镜、结肠镜及血管造影等检查，均未定位到出血灶。遂行核素显像检查，结果显示右侧腹部放射性示踪剂摄取增高，符合小肠出血表现。结合上述检查结果，患者接受紧急剖腹手术并行病变切除术。术后病理组织学检查结果符合杜氏溃疡(Dieulafoy lesion)。本病例阐明了多种影像学及内镜检查手段联合应用，对定位消化道全程出血灶的重要临床价值。