Multiple Dieulafoy's Lesions are a Rare Cause of Upper Gastrointestinal Bleeding: A Case Report

Background:

Dieulafoy's lesions are a rare cause of bleeding in the upper gastrointestinal tract. Usually less than one percent of all bleeding ulcers are caused by Dieulafoy's ulcers¹. It is a visible vessel predominantly in the fundus, probably representing a dysplastic large artery. If the overlying mucosa is eroded, massive hemorrhage may occur. Endoscopic therapy with hemoclips has proven quite successful^2,3.

Case presentation:

A 86 year-old female patient presented with acute shortness of breath, paleness, intermittent thoracic tightness and a hemoglobin of 7.6g/dl. At initial endoscopy, a bleeding source was not detected. After another hemorrhage 5 days later, repeat endoscopy showed three Dieulafoy's lesions at the anterior and posterior walls of the gastric corpus which were successfully treated with hemoclipping. No recurrent bleedings occurred within a follow-up period of 3 months.

Conclusion:

Accurate endoscopic examination and, sometimes, repeat endoscopies are needed to verify the diagnosis of Dieulafoy's lesions. Hemoclipping represents an effective endoscopic intervention and should be regarded as the treatment of choice in Dieulafoy's disease. The occurrence of multiple lesions in different sites of the stomach challenges the concept of malformation of a single submucosal artery.