Duodenal Dieulafoy’s Lesion-arising Awareness of this Rare Cause of Gastrointestinal Bleed

Abstract

Aim: The aim of this report is to raise awareness about the risk of bleeding associated with duodenal Dieulafoy lesions (DLs) and to emphasize the importance of utilizing imaging modalities when DLs are suspected as the cause of bleeding. Presentation: This case study reports a 68-year-old male who presented with non-bloody vomiting and multiple episodes of hematochezia. An angiogram revealed active bleeding in the duodenum, which was subsequently identified and treated on the first attempt during endoscopy as a bleeding duodenal DL. Discussion: DLs are a rare cause of gastrointestinal bleeding, characterized by dilated submucosal vessels that have a tortuous path, making them susceptible to erosion. They are most commonly found in the stomach, and are extremely rare in the duodenum, often requiring multiple endoscopic attempts to identify and treat. However, we were able to successfully treat our patient upon the first attempt with the help of angiogram prior to endoscopy.  Use of multiple methods to achieve hemostasis (epinephrine injection, heat probe, and hemoclips) is effective in treating DLs.  Conclusion: It is important to recognize DLs as a potential cause of gastrointestinal bleeding, given their high mortality rate. The use of imaging prior to endoscopy can potentially prevent the need for multiple attempts at identifying and treating the lesion.