Dieulafoy’s Surprise: An Unexpected Source of Upper Gastrointestinal Bleeding - A Case Report

Abstract

The patient presented with symptoms typical of UGIB, including hematemesis and melena. Diagnostic gastroscopy revealed a Dieulafoy's lesion in the gastric fundus. Multiple endoscopies were required for a definitive diagnosis, consistent with the challenging nature of identifying Dieulafoy's lesions. A 40-year-old Indian male with untreated hypertension presented to the emergency room with hematemesis and abdominal pain after consuming alcohol. He had a history of chronic smoking. Initial vital signs showed tachycardia, and lab results indicated elevated liver enzymes. An urgent upper GI endoscopy revealed a bleeding Dieulafoy's lesion in the fundus, which was treated with hemoclips. The patient received blood products and medication infusions. He was discharged after 4 days with no complications and advised on potential future treatment if rebleeding occurs. Endoscopic treatment was employed, combining injection therapy with mechanical methods such as hemoclip application, which is considered the most effective approach. The patient responded well to endoscopic treatment, achieving successful hemostasis. This case highlights the importance of considering Dieulafoy's lesion in the differential diagnosis of UGIB, especially when initial endoscopic findings are inconclusive. Early recognition and appropriate endoscopic intervention are crucial for the successful management of this potentially life-threatening condition.