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Extragastric Dieulafoy's lesion
James Gauci1, Samuel Galea2, Joseph Galea2
1Department of General Medicine, Mater Dei Hospital, Swieqi, Malta.
BMJ Case Reports
|September 14, 2014
Summary
Recurrent gastrointestinal bleeding in a patient on warfarin was caused by an extragastric Dieulafoy's lesion. Managing this duodenal vascular lesion proved challenging despite multiple endoscopic and surgical interventions.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Interventional Radiology
Background:
- A 74-year-old male on warfarin for aortic valve replacement experienced recurrent melaena.
- Initial investigations including esophagogastroduodenoscopy (OGD), red cell scan, and colonoscopy were inconclusive.
Observation:
- A third OGD identified an extragastric Dieulafoy's lesion in the duodenum (D1-D2 junction).
- The lesion was initially treated with epinephrine injection and tattooing.
Findings:
- Despite multiple interventions, including further injections, embolization, and surgical oversuturing, bleeding recurred.
- The patient underwent over 10 endoscopies and received over 70 units of packed red cells in 6 years.
Implications:
- This case highlights the diagnostic and therapeutic challenges in managing extragastric Dieulafoy's lesions.
- Persistent gastrointestinal bleeding from such lesions necessitates a multidisciplinary approach and may require aggressive management strategies.
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