Dieulafoy’s Lesion: Something Not to Be Forgotten

An 86-year-old male with hypertension presented to the Emergency Department with hematemesis and melena.He was hypotensive with a hemoglobin of 7.1 grams/deciliter and was admitted to the hospital.The next day endoscopy was performed.There was Grade A esophagitis and old blood in the stomach, without ulcers or erosions.The duodenum was normal and the culprit lesion was first thought to be the esophagitis.He did well for a few days but developed melena and drop in his hemoglobin.He underwent a push enteroscopy to reevaluate the stomach and small intestines as well as a colonoscopy.There was fresh blood and blood clots in the fundus of the stomach.After clearing the clots there was an active bleeding consistent with a Dieulafoy's lesion a few centimeters from the gastroesophageal junction.Three metallic clips were placed for hemostasis and two milliliters 1:10,000 epinephrine injected submucosally around the site with successful hemostasis.The patient had no further melena and was discharged home a few days later.