Dieulafoy’s Lesion: A Rare and Elusive Cause of Massive Upper Gastrointestinal Bleeding Managed With Endoscopic Therapy

A Dieulafoy's lesion is a rare vascular anomaly that can cause massive upper gastrointestinal bleeding. It often presents with hematemesis and requires prompt diagnosis and intervention. We report a case of a 54-year-old male patient with hypertension and diabetes mellitus who presented to the emergency department with hematemesis. After the initial resuscitation, an esophagogastroduodenoscopy revealed a pulsatile submucosal artery in the proximal stomach, consistent with a Dieulafoy's lesion. No evidence of peptic ulcer disease, gastric varices, or malignancy was noted. Endoscopic hemostasis was achieved using an epinephrine injection followed by thermal coagulation. The patient's hospital course was uncomplicated, with no further bleeding episodes. Computed tomography angiography confirmed the diagnosis and ruled out other potential sources of bleeding. The patient was discharged on a proton pump inhibitor regimen and scheduled for a follow-up endoscopy in six weeks, which showed complete mucosal healing. A Dieulafoy's lesion remains a challenging diagnosis due to its subtle presentation and requires a high index of suspicion, especially in patients with unexplained gastrointestinal bleeding. Endoscopic therapy is highly effective in managing this condition and, when promptly addressed, results in excellent outcomes. This case highlights the importance of early recognition and intervention, contributing to the growing body of evidence supporting the role of endoscopy in the management of Dieulafoy's lesion.