Bleeding “Dieulafoy’s-like” lesion resembling the duodenal papilla: a case report

Abstract

IntroductionDieulafoy’s lesion is an uncommon but important cause of gastrointestinal bleeding in which hemorrhage occurs from a pinpoint, non-ulcerated arterial lesion. DLs are usually located in the stomach, most commonly in people between the ages of 50 and 70 years. In this report, we describe a teenage patient with an unusual presentation of a bleeding duodenal Dieulafoy’s-like lesion that resembled the duodenal papilla.Case presentationAn 18-year-old Pakistani woman presented to our emergency department with hematemesis of 6 hours’ duration. Her past medical history was unremarkable. A nasogastric aspirate was negative for blood. The patient’s hemoglobin was found to be 4g/dl. She was resuscitated with intravenous fluids and blood transfusion. An esophagogastroduodenoscopy was performed, which revealed swelling in the first part of the duodenum, the initial appearance of which suggested that it was an abnormally placed or accessory papilla. There was a small, <3–mm opening on the lesion that resembled the biliary or pancreatic orifice. On gentle manipulation with a catheter, blood spurted from the swelling area, and a vessel was visible. Adrenaline was used for hemostasis. After hemostasis was achieved, it became clear that the lesion was most consistent with a Dieulafoy’s-like lesion and not a papilla. Band ligation was then performed, and the patient did not develop any complications and did not have any further episodes of bleeding. The patient was eventually discharged to home in stable condition.ConclusionsThis case report highlights the importance of considering a DL as a cause of small-bowel hemorrhage and recognizing its potential resemblance to the papilla. Although the endoscopic diagnostic criteria for a Dieulafoy’s lesion have been described in great detail, there is a paucity of literature describing a Dieulafoy’s lesion or a similar lesion resembling the duodenal papilla.

Upper digestive hemorrhage secondary to major duodenal papilla Dieulafoy’s lesion: Case report

“…Although rare, duodenal DL lesions was previous described (Inayat et al, 2018;Ibrarullah and Wagholikkar, 2003;Murali et al, 2017) including one bleeding Dieulafoy's-Like lesion resembling the duodenal papilla (Bilal et al, 2015) and a DL inside a duodenal diverticulumn (He et al, 2020). A Periampullary lesion has been previous described as cause of an obscure gastrointestinal bleeding and needed surgery treatment after endoscopic and arteriographic fail (Rana et al, 2010).…”

Duodenal Dieulafoy lesion: a rare pathogeny of gastrointestinal bleeding in children

“…We searched previous literature with "duodenum", "Dieulafoy" and "children" as keywords, and a total of 9 cases related to the diagnosis and treatment of DL were retrieved (Table I). [10][11][12][13][14][15][16][17][18] 3 cases were successfully diagnosed and effectively treated under endoscopy, 1 case was successfully treated with duodenotomy, 1 case died 4 hours after surgery, 4 cases were successfully treated with other methods after failed diagnosis or treatment under endoscopy (angiographic embolization in 2 cases, exploratory laparotomy in 2 cases). The case we reported was effectively diagnosed and treated after receiving endoscopy, surgical exploration, endoscopy, and selective angiography, and has been followed up for 10 months without recurrence.…”