Case report: Dieulafoy's lesion as a rare cause of massive gastrointestinal hemorrhage

Introduction and importance: Dieulafoy's lesion is a rare but serious cause of gastrointestinal bleeding, typically affecting older adults. It involves an aberrant arteriole eroding the gastric mucosa, resulting in severe, recurrent bleeding that poses diagnostic and management challenges. We present a case report of massive gastrointestinal hemorrhage with hemodynamic instability associated with a Dieulafoy's lesion.

Case presentation: A 55-year-old male with no significant medical history presented with gastrointestinal bleeding, showing signs of hematemesis and melena. He was hemodynamically unstable upon admission, with a hemoglobin level of 6 g/dL. After resuscitation and stabilization, an esophagogastroduodenoscopy revealed a 5 mm Dieulafoy lesion in the fundus, treated successfully with hemostatic clips. The patient had an uneventful recovery and was discharged on the fourth day, with normal follow-up at one year and no complications.

Clinical discussion: Dieulafoy's lesion, a rare cause of gastrointestinal bleeding, is found in 1-2 % of cases, primarily in males over 60 years old. First described by Dieulafoy, it results from an aberrant arteriole erosion, commonly in the upper stomach. Diagnosis is challenging during active bleeding and often requires multiple endoscopies. Mechanical hemostasis methods during endoscopy are effective, with recurrence rates of 8-10 %. Surgical intervention is reserved for severe, uncontrolled cases.

Conclusion: Dieulafoy's lesion, though rare, requires prompt diagnosis and effective endoscopic treatment to manage severe bleeding. Combining hemostatic techniques or surgical options may be necessary to address persistent cases and improve patient outcomes.