Surgical Treatment of a Refractory Gastroesophageal Junction Dieulafoy Lesion Using Intraoperative Endoscopic Tattooing

Introduction: Dieulafoy’s lesion (DL) is a rare but potentially life-threatening cause of upper gastrointestinal bleeding. Endoscopic therapy is the first-line treatment; however, recurrent bleeding may necessitate surgical intervention.Case Report:A 55-year-old male presented to the emergency department with hematemesis and hemodynamic instability. Initial endoscopy revealed a Dieulafoy’s lesion in the gastric fundus with active bleeding. Hemostasis was achieved with epinephrine injection, thermal coagulation, and hemoclip placement, and temporary stabilization was obtained after blood transfusion. On the third hospital day, recurrent bleeding required repeat endoscopy and an additional hemoclip application, but the patient continued to experience symptoms. On day eight, intraoperative endoscopic tattooing with methylene blue facilitated accurate localization of the lesion, and wedge resection was performed. The postoperative course was uneventful, and histopathological examination confirmed the diagnosis of DL.Conclusion:This case demonstrates that intraoperative endoscopic marking is a valuable adjunct in refractory Dieulafoy’s lesions, enabling precise localization, avoiding unnecessary radical surgery, and allowing successful limited resection.