Duodenal Dieulafoy’s lesion- challenges in diagnosis: A Case report

Abstract

Dieulafoy’s lesion is a rare but potentially life-threatening cause of upper gastrointestinal (GI) bleeding, typically presenting with severe ‘haematemesis, melaena, or haematochezia without prior symptoms, often with hemodynamic instability requiring transfusion of multiple units of packed erythrocytes. Diagnosis is frequently challenging due to its subtle endoscopic appearance and obscure location of the lesion. Early endoscopy during a bleeding episode is essential for an accurate diagnosis and sometimes multiple endoscopies are needed to establish the diagnosis. Here, we present a case of a 51-year-old female with multiple comorbidities, including end-stage renal disease (ESRD) on maintenance hemodialysis and ischemic heart disease, who presented with persistent melaena for one month. After extensive evaluation, she was diagnosed with Dieulafoy’s lesion in the duodenum. Prompt endoscopic management stabilized her condition. This case highlights the diagnostic challenges and clinical importance of recognizing Dieulafoy’s lesion in patients with complex medical histories.