Unusual presentation of duodenal Dieulafoy's lesion in a toddler

Area of Science:

• Gastroenterology
• Pediatric Medicine
• Vascular Malformations

Background:

• Dieulafoy's lesion is an uncommon cause of significant upper gastrointestinal bleeding.
• Typically, these lesions are found in the proximal stomach.
• They involve an aberrant, large submucosal artery eroding into the gastrointestinal tract.

Observation:

• A pediatric patient presented with acute, massive rectal hemorrhage.
• Nasogastric aspirate was clear, ruling out significant upper GI bleeding proximal to the duodenum.
• Endoscopic evaluation revealed a Dieulafoy's lesion in the duodenum.

Findings:

• The duodenal Dieulafoy's lesion was identified as the source of massive rectal bleeding.
• This presentation is atypical, as Dieulafoy's lesions are more commonly associated with upper GI bleeding.
• The lesion's location in the duodenum caused lower gastrointestinal bleeding symptoms.

Implications:

• This case expands the known clinical presentations of Dieulafoy's lesions.
• It underscores the importance of considering duodenal Dieulafoy's lesions in pediatric patients with massive lower GI hemorrhage.
• Accurate diagnosis requires thorough endoscopic evaluation to identify the bleeding source, even with atypical symptoms.