A Tale of Three Dieulafoy Lesions: A Case Report and Review of the Literature

Abstract

A Dieulafoy lesion (DL) is a rare cause of non-variceal upper gastrointestinal hemorrhage. It is a large submucosal artery that lies in close proximity to the mucosal surface without any evidence overlying superficial ulcers. DLs can be found anywhere within the gastrointestinal (GI) tract, but are frequently encountered within the stomach. Most cases documented in the literature only describe isolated, single DLs occurring within the GI tract. Herein, we describe an unusual case of an elderly female with a medical history of compensated alcoholic liver cirrhosis who presented with massive hematemesis and endoscopy unveiled three DLs within the gastric cardia as the source of hemorrhage. The bleeding was successfully managed using novel endoscopic modalities such as Hemospray (Cook Medical, Bloomington, IN). We also provide an updated literature review on the diagnosis, pathophysiology as well as recent advances in the management of DLs.

Multiple Gastric Dieulafoy Lesions

“…With advancement in endoscopic, radiologic, and surgical techniques, rebleed and mortality have been reduced to less than 10%. 9 Very limited literature is available regarding multiple or synchronous DLs. 9 This is the first reported case of multiple gastric DLs with failed endoscopic treatment undergoing surgery and histopathology confirming multiple DLs.…”

“…9 Very limited literature is available regarding multiple or synchronous DLs. 9 This is the first reported case of multiple gastric DLs with failed endoscopic treatment undergoing surgery and histopathology confirming multiple DLs.…”

“…With advancement in endoscopic, radiologic, and surgical techniques, rebleed and mortality have been reduced to less than 10%. 9…”

A Challenging Case of Jejunal Dieulafoy’s Lesion: A Rare Cause of Refractory Lower-Gastrointestinal Bleeding

“…Adding injection sclerotherapy as an adjunct may be beneficial in such cases, as it has been reported to be 100% successful when supplementing hemoclipping, with no incidents of rebleeding in the 18 jejunal DLs in which this approach was implemented [ 2 ]. Novel endoscopic treatment modalities could be of further use, as was applied in 1 case study, with the successful use of Hemospray ® following failure to control 3 bleeding DLs with epinephrine injections and endoclips [ 12 ]. A randomized controlled trial later supported this approach, as Hemospray ® was found to be just as effective as the hemoclip, with a non-significant increased rebleeding rate, although it is typically used as a temporary measure rather than a definitive one in the management of DLs [ 13 , 14 ].…”

Massively bleeding Dieulafoy lesion and unique rescue: a video based case report from National Liver Institute, Menoufia University

“…Up till now, a consensus treatment for Dieulafoy bleeding is not available and different modalities are used depending on the patient's presentation and the endoscopic experience of the endoscopy personnel [20].…”