Bleeding at the Crossroads: A Rare Dieulafoy’s Lesion in A Gastro-Colonic Anastomosis

Dieulafoy’s lesion (DL) is a rare but significant cause of gastrointestinal bleeding, typically found in the stomach along the lesser curvature. Reports of DL at surgical anastomosis sites are rare, with to our knowledge no documented cases involving a gastro-colonic anastomosis. We report the case of a 65-year-old female with a history of esophagectomy, chronic hemodialysis and rheumatoid arthritis, who presented with hematemesis, melena, and epigastric pain. gastroscopy revealed a postsurgical gastro-colic anastomosis harboring a 5-mm Dieulafoy lesion. Hemostasis was successfully achieved using epinephrine injection and hemostatic clips. The patient’s recovery was uneventful. This case represents to our knowledge the first reported instance of a Dieulafoy lesion at a gastro-colonic anastomosis site. The rarity of this presentation emphasizes the importance of considering DL in differential diagnoses of gastrointestinal bleeding in patients with complex surgical anatomy. Endoscopic intervention remains the cornerstone of diagnosis and treatment, with mechanical hemostasis offering high success rates. Early recognition and prompt endoscopic management are also crucial for favorable outcomes.