A 72-year-old man with hypertension was admitted to our hospital because of temporary stupor. On admission, neurological examination and brain magnetic resonance imaging showed no remarkable findings. Hemoglobin concentration of the blood was 14.4 g/dL. He developed shock following melena (day 1). Hematological examination after the shock revealed hemoglobin of 7.6 g/dL. Blood transfusion was performed. Initial gastrointestinal endoscopy and colonoscopy performed 4 h after the shock revealed blood in the colon, but did not reveal mucosal changes and the bleeding source. A second gastrointestinal endoscopy performed after a second shock revealed faint backward flow of the intestinal bleeding from the jejunum and did not show bleeding source in the esophagus, stomach and duodenum (day 2).Computed tomography (CT) and angiography performed on day 2 revealed the bleeding source ( Fig. 1a-d). Although radiologists performed transcatheter arterial embolization (Fig. 1e), the patient developed a third shock following melena (day 4). A third gastrointestinal endoscopy showed a Dieulafoy's lesion (DL) in the jejunum (Fig. 1f,g). We applied two clips and an endoscopic local injection of hypertonic salineepinephrine solution. The hemostasis was successful. We could not perform gastrointestinal endoscopy after the treatment because of disappearance of melena and patient refusal. As in a similar previous report, 1 we speculate that the DL in our case healed and disappeared. However, this could not be proven.Dieulafoy's lesion is a vascular malformation and a rare but potentially life-threatening disease 1-4 that is responsible for 7% of upper gastrointestinal hemorrhage. 3 DL in the small intestine is extremely rare, and the diagnosis is difficult.

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