Duodenal Dieulafoy’s lesion: A rare cause of gastrointestinal hemorrhage in two Ethiopian patients – Case report

Dieulafoy’s lesion (DL) is a rare vascular abnormality characterized by an abnormally large submucosal artery that can cause life-threatening gastrointestinal bleeding. While the stomach is the most common site, duodenal involvement is uncommon and frequently overlooked. We report two Ethiopian patients presenting with acute gastrointestinal bleeding due to duodenal Dieulafoy’s lesion. The first was a 42-year-old woman with hematemesis, melena, epigastric discomfort, and anemia, whose initial esophagogastroduodenoscopy (EGD) at another center was unremarkable. The second was a 42-year-old man with worsening melena, epigastric discomfort, fatigue, and anemia. In both patients, repeat EGD revealed actively bleeding vascular lesions in the duodenum. Hemostasis was successfully achieved using adrenaline injection and/or hemoclip application. Both patients received blood transfusions, proton pump inhibitors, and supportive care, and were discharged with normalized hemoglobin at two-week follow-up. Dieulafoy lesions are rare but significant causes of massive gastrointestinal bleeding, which often pose diagnostic challenge due to their subtle endoscopic appearance. High clinical suspicion in cases of unexplained hematemesis or melena, along with prompt endoscopic intervention, can achieve effective hemostasis and prevent life-threatening complications. • Duodenal Dieulafoy’s lesion is a rare cause of acute GI bleeding. • Initial endoscopy may miss duodenal DL, highlighting diagnostic challenges. • Early recognition and prompt endoscopic intervention can prevent severe hemorrhage.