Abstract
BackgroundDieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding. Extragastric location of Dieulafoy's lesion is rare. We report two cases of Dieulafoy's lesion of the duodenum and discuss the management of this extremely uncommon entity.Case presentationTwo cases of massive upper gastro-intestinal bleeding in young adults due to Dieulafoy's lesion of the duodenum are reported. Endoscopic diagnosis was possible in both cases. Hemostasis was achieved successfully by endoscopic adrenaline injection. The endoscopic appearance, pitfalls in the diagnosis and management of this rare lesion are discussed.ConclusionsEndoscopic diagnosis of extragastric Dieulafoy's lesion can be difficult because of the small size and obscure location of the lesion. Increased awareness and careful and early endoscopic evaluation following the bleeding episode are the key to accurate diagnosis. Adrenaline injection is one of the important endoscopic modalities for control of bleeding.
Highlights
Dieulafoy's lesion is an uncommon but important cause of recurrent upper gastrointestinal bleeding
We report two cases of recurrent massive upper GI bleeding from Dieulafoy's lesion (DL) in duodenum
75 – 95 % DLs are found within 6 cms of the gastro-esophageal junction predominantly on the lesser curvature which is possibly related to the peculiar vascular anatomy of the stomach in this region [1]
Summary
Duodenal DL is an uncommon but important cause of recurrent and significant upper GI bleeding. Endoscopic adrenaline injection is an important technique to control the bleeding. The lesions in both the patients were amenable to endoscopic adrenaline injection. The other endoscopic hemostatic techniques apart from adrenaline injection include bipolar and monopolar electrocoagulation, heater probe, laser photocoagulation, injection sclerotherapy, hemoclipping and endoscopic band ligation (EBL)[1,6,9]. Some Japanese groups have suggested the use of vascular clips as an effective and safe method of hemostasis in DLs in thin walled organs like duodenum. Nikolaidis et al have reported successful control of bleeding in 96% (n = 22/23) patients with Dieulafoy like lesions who were treated by EBL [10]. Chung et al in a comparative study of efficacy of hemo-
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