A Dieulafoyʼs Lesion: Accessory Splenic Artery

Abstract

A 67 year old male who presented as a transfer from outside hospital (OSH) for evaluation of recurrent GI bleed. He had been hospitalized 3 times in the last month prior to presentation and required multiple blood transfusions. The workup so far including EGD, colonoscopy and CTA had been unrevealing except for AVMs, s/p argon plasma coagulation. Pt presented with intermittent melena, denied abdominal pain, lightheadedness. Past medical history was significant for hypertension, AAA repair. Home medications included aspirin which was held and protonix. Laboratory findings revealed anemia with no coagulopathy. Capsule endoscopy revealed blood in the stomach. EGD done within an hour of dropping the capsule did not show blood in the stomach/duodenum. Pt did require blood transfusion. The OSH CT angiogram that was re-read by our hospital showed an unusually prominent and tortuous Accessory Splenic Artery (ASA) arising from the Left Gastric artery (LGA) in the gastric fundus. The decision to repeat the EGD was taken. On careful re-examination what had originally been thought to be a prominent gastric fold was a large, tortuous, and highly pulsatile sub mucosal vessel in the cardia/fundus, which could be described as a Dieulafoy's Lesion. This was thought to be the most likely reason for the GI bleed. Pt underwent successful coil embolization of the proximal portion of the ASA. Melena resolved thereafter and patient was discharged. We are reporting this case of ASA presenting as Dieulafoy's lesion causing recurrent GI bleeding. There has been one other case reported in Turkey where a 42 Y/o male presented with massive UGIB. EGD showed isolated gastric varices in fundus. Angiography showed an ASA situated in the gastric wall arising from LGA. The patient was treated with ASA embolization and did well thereafter.Figure 1Figure 2Figure 3