DIEULAFOY'S LESION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: A Dieulafoy's lesion was first described by Dr. M. T. Gallard in 1884, but the name followed after a French surgeon, Paul Georges Dieulafoy, who presented three cases of "submucosal arterioles" stomach 1898. Although this is rare lesion, it an important etiology gastrointestinal (GI) hemorrhage that clinicians need to be aware of. CASE PRESENTATION: 63 year-old female with underlying chronic alcohol use came Emergency Department (ED) for evaluation hematemesis. Before coming ED, she had two episodes large hematemesis, as well passing black-tarry stool. She also reported very similar occurred few years ago, at time, did not seek any medical attention since her symptoms resolved on their own. been drinking glass vodka per day more than 30 years, and about 40 pack-year smoking history well. Upon presentation initial hemoglobin 6.2 g/dL so 2 units PRBC were given, liver enzymes all normal. esophagogastroduodenoscopy (EGD) or colonoscopy 20 years. After patient stabilized, EGD performed, showed gastric body. Two hemoclips placed lesion. No esophageal varices ulcers found. no GI bleeding episode until being discharged. strongly advised quit cigarettes, agreed do so. DISCUSSION: made histologically normal vessels abnormally diameters run tortuous course within submucosa protrude into defective mucosa "bulge." More 90% lesions are found upper tract majority stomach, endoscopy standard diagnostic method. The treatment goal endoscopic hemostasis, multiple methods using thermal coagulation, hemoclips, band ligation, etc., have successfully used achieve hemostasis. Interestingly, seen case, might tempting "assume" probably esophagus variceal because long heavy history. However, varices, Thus, when they encounter patients present bleeding, if found, proper management must done prevent another occurrence. CONCLUSIONS: rare, accounts 1-2% acute cases. hemostasis through endoscopy. Since can life-threatening, mindful lesions, achieved from REFERENCE #1: Baxter M, Aly EH. lesion: current trends diagnosis management. Ann R Coll Surg Engl. 2010;92(7):548-554 #2: Inayat F, Amjad W, Hussain Q, Hurairah A. duodenum: comparative review 37 BMJ Rep. 2018;2018:bcr2017223246 #3: Pineda-De Paz MR, Rosario-Morel MM, Lopez-Fuentes JG, Waller-Gonzalez LA, Soto-Solis R. Endoscopic massive rectal report. World J Gastrointest Endosc. 2019;11(7):438-442 DISCLOSURES: relevant relationships Sung Deuk Kim, source=Web Response