Dieulafoy Duodenal Ulceration: A Rare Cause of Massive Digestive Hemorrhage

Abstract

Dieulafoy ulceration (DU) is a rare cause of digestive hemorrhage. It usually occurs in the upper half of the stomach. Other duodenal, jejunal and even colonic localizations have been described, but are much rarer. We report a case of duodenal Dieulafoy ulceration causing upper GI hemorrhage in a 74-year-old female patient, initially admitted to intensive care for melena with signs of hypovolemic shock. She had a history of non-valvular atrial fibrillation on DOAC, with no other antecedents. An oeso-gastro-duodenal fibroscopy was performed after hemodynamic stabilization and transfusion of 4 packed red blood cells, and showed active bleeding of duodenal origin from a punctiform ulceration at D3. Hemostasis was achieved by placement of a hemostatic clip with no immediate complications. The patient remained stable during hospitalization with no further deglobulisation; hemoglobin was stable at 9.1 g/dL. She was discharged after 7 days of hospitalization without complications. The patient was seen for a follow-up consultation, and showed no further recurrence of bleeding after 5 months. Dieulafoy ulceration is a particular form of duodenal ulcer confined to an artery of abnormal caliber, which can lead to cataclysmic hemorrhage. Endoscopic diagnosis can be very difficult, particularly in the first episode.The hemoclip has proved safe and effective in controlling bleeding due to Dieulafoy ulceration.