A Rare Dieulafoy Lesion in the Second Portion of the Duodenum: Successful Endoscopic Hemostasis

Dieulafoy's ulcer is a rare but potentially fatal vascular malformation characterized by the presence of an abnormally large submucosal arteriole that erodes the overlying mucosa without an identifiable primary ulceration. Its duodenal location is exceptional. We report the case of a 76-year-old patient with multiple comorbidities, admitted to the emergency department of the Avicenne Military Hospital in Marrakech for melena that had been progressing for four days, accompanied by severe anemia (Hb 5.4 g/dL). An upper gastrointestinal endoscopy (EGD) revealed a Dieulafoy's lesion in the second part of the duodenum (D2), with spontaneous, diffuse bleeding and no visible ulceration. Endoscopic hemostasis was achieved by injection of adrenaline (6 cc) followed by the placement of two hemostatic metal clips, with a good clinical outcome.