We present a case of severe upper gastrointestinal bleeding due to Dieulafoy's lesion in a boy in early adolescence, likely triggered by a short-term treatment of anti-inflammatory drugs (NSAIDs) and ongoing selective serotonin reuptake inhibitor (SSRI) therapy. The patient initially presented with hip pain, fever, vomiting and diarrhoea and was treated with NSAIDs for suspected reactive coxitis. He was later diagnosed with pyomyositis. His history included anxiety disorder treated with SSRIs. Clinical findings revealed elevated inflammatory markers, joint infection with Staphylococcus aureus and acute haematemesis leading to hypovolaemic shock. Emergency gastroscopy identified a Dieulafoy's lesion, which was successfully treated with endoscopic haemostatic clips. He received blood transfusions and supportive therapy and recovered fully. On discharge, he was prescribed antibiotics, proton pump inhibitors and iron supplements. NSAIDs were contraindicated for future use, and the adverse reaction was reported to the Danish medicines agency.This case highlights the risk of Dieulafoy-related bleeding in children from the short-term use of NSAIDs in combination with ongoing SSRI therapy.

Acute pancreatitis following endoscopic hemostasis of a periampullary Dieulafoy lesion: successful rescue by endoscopic retrograde cholangiopancreatography

Dieulafoy's lesion (DL) is an uncommon cause of nonvariceal upper gastrointestinal bleeding (NVUGIB). The weekend effect refers to the phenomenon where patients admitted on weekends experience clinically poorer outcomes. This study aimed to explore the weekend effect on clinical outcomes after endoscopic hemostasis for DL in the upper gastrointestinal tract, and whether this relationship was mediated by the experience of the endoscopist. This retrospective analysis included patients with DL of the upper gastrointestinal tract who underwent standard endoscopic hemostasis treatment between April 2007 and June 2025. Univariate and multivariate analysis, propensity score matching (PSM), and mediation analysis were used to explore the relationships between the weekend effect, the experience of the endoscopist and the rebleeding rate of DL. A total of 283 patients were included in this study, consisting of 212 patients in the weekday admission group and 71 patients in the weekend admission group. Multivariate analysis showed weekend admission was an independent risk factor for rebleeding of DL. After matching, the baseline characteristics of 64 patients in the weekday admission group and 64 patients in the weekend admission group were balanced. The rebleeding rate of DL in the weekend admission group was significantly higher than that in the weekday admission group (31.3% vs. 10.9%, P = 0.005). Patients admitted on weekends were more likely to be treated by less-experienced endoscopists compared to those admitted on weekdays (48.4% vs. 25.0%, P = 0.006). Moreover, a significant indirect effect of the weekend effect on rebleeding of DL through less-experienced endoscopists was found, and the proportions mediated were 17.42%. The weekend effect was significantly associated with the higher rebleeding rate in patients with DL of the upper gastrointestinal tract, and less-experienced endoscopists on weekends might be playing a mediating role in this relationship.

Cecal Dieulafoy Lesion.

Background: Dieulafoy lesion (DL) is a rare gastrointestinal (GI) vascular anomaly characterized by the presence of a large-caliber submucosal artery, which can cause severe, recurrent hemorrhage when ruptured. Clinical Description: A 15-year-old boy with a known history of essential hypertension and obesity presented with acute-onset, recurrent bloody stools, associated with profound anemia. Cardiorespiratory and abdominal examination was normal. Management and Outcome: Baseline routine laboratory parameters, including coagulation profile, were normal, except anemia. Meckel’s scan revealed a suspicious marker in mid abdomen. Upper and lower GI endoscopy, video capsule endoscopy, including biopsies, diagnostic abdominal laparoscopy, and computed tomography angiography of the abdomen and pelvis did not reveal the source of bleeding. The patient was discharged after supportive treatment, only to be re-admitted for recurrence. Emergency colonoscopy, this time, revealed a well-defined DL in the transverse colon. The lesion was treated with epinephrine injection and thermocoagulation. Patient improved, and no recurrence of bloody stools was noted at follow-up. Conclusion: Dieulafoy lesion is a rare condition and often overlooked as a cause of GI tract bleeding in children, which may require multiple endoscopies for visualization.

S4650 Active Gastrointestinal Bleeding From Dieulafoy Lesion on Abdominal Computed Tomography Angiography Imaging

S4670 Dieulafoy Lesion in a Post–Deceased Donor Liver Transplant Patient: A Rare Cause of Upper GI Bleeding

Use of antiplatelets, anticoagulants, or aspirin/NSAIDs increases the risk of major gastrointestinal (GI) bleeding. This study aimed to analyze esophagogastroduodenoscopy (EGD) findings in patients treated with these drugs (drug-exposed) versus those who were not (non-exposed), who presented with signs suggestive of nonvariceal upper GI bleeding. This retrospective cohort study included patients aged over 16 years with signs suggestive of upper GI bleeding, no history of gastrointestinal malignancy, and no portal hypertension or varices, hospitalized at the General Hospital of Ioannina, Greece, from January 2019 to October 2023. Differences between the two patient groups were tested for significance with the chi-square test. Relative Risk (RR) and Odds Ratio (OR) were calculated to assess the association between drug exposure and endoscopic findings. A p-value less than 0.05 was consider ed statistically significant. A total of 405 patients (268 males; mean age 73.1 ± 16.8 years) were enrolled: 303 drug-exposed (193 males; mean age 77.6 ± 12.2) and 102 non-exposed (75 males; mean age 59.7 ± 20.9). Peptic ulcer disease (PUD) was the most common bleeding cause. Drug exposure was strongly associated with vascular lesions (angiodysplasias, Dieulafoy's lesion, GAVE) (RR: 12.12, 95% CI: 1.68-87.3, p = 0.01; OR: 13.62, 95% CI: 1.84-100.64, p = 0.002). Notably, 75% of angiodysplasia cases occurred in anticoagulant-treated patients, with 50% receiving DOACs. Upper GI bleeding in patients on antiplatelets, anticoagulants, or NSAIDs/aspirin should prompt suspicion of pre-existing lesions, particularly PUD and angiodysplasias.

Dieulafoy's lesion is a rare but potentially life-threatening cause of gastrointestinal (GI) bleeding, with its rarity possibly attributing to unawareness and underdiagnosis. Due to its subtle presentation and the potential for massive bleeding, Dieulafoy's lesion often poses a diagnostic challenge. This report presents the case of a 68-year-old patient with upper GI bleeding, where computed tomography (CT) angiography confirmed a Dieulafoy's lesion which was successfully treated with endoscopic hemoclip application. The aim of this article is to increase awareness about Dieulafoy's lesion and to stress the importance of CT angiography in cases where Dieulafoy's lesion might be missed during endoscopy.

Dieulafoy lesions are a rare, non-variceal cause of gastrointestinal (GI) bleeding arising from dilated submucosal arteries without any underlying ulcer, which if undiagnosed can cause significant morbidity and mortality. We present a young female with massive upper and lower GI bleeding with haemodynamic instability, the source of which could not be identified with upper and lower endoscopy or radiological investigations. We therefore employed capsule endoscopy, which identified the location as the mid-jejunum. In view of ongoing bleeding, an emergency laparotomy with resection and anastomosis of the affected bowel was performed. Massive obscure small bowel bleeds pose major diagnostic and therapeutic challenges, which can be tackled only by timely intervention.

Expanding Horizons of Vascular Interventions: Endoscopic Ultrasound-Guided Angioembolization for a Refractory Upper Gastrointestinal Bleed From a Gastric Dieulafoy Lesion

Canadian Association of Gastroenterology Clinical Practice Guideline for the Endoscopic Management of Nonvariceal Nonpeptic Ulcer Upper Gastrointestinal Bleeding.

Cap pressure characterization and band ligation for a tiny duodenal angioectasia with acute feeding vessel bleeding mimicking a Dieulafoy lesion.

Dieulafoy lesion (DL) is a rare yet potentially life-threatening cause of gastrointestinal bleeding. This study retrospectively analyzed all patients diagnosed with DL over the past two decades, focusing on clinical outcomes such as rebleeding and mortality. We aimed to identify factors associated with these outcomes to improve the understanding and management of this condition. This study included 39 hospitalized patients who underwent endoscopy for gastrointestinal bleeding and were diagnosed with Dieulafoy lesions. Data were collected retrospectively, and regression analysis was performed to assess factors associated with all-cause mortality and rebleeding rates. The study included 39 patients, with a mean age of 64 years; 13 (33%) were women. The most common presenting complaint was hematemesis (41%). The most common localization of DLs was the stomach, with 25 (64.1%) DLs detected. Rebleeding rates within one week and mortality within 90 days were 33% and 28%, respectively. In univariate analysis, esophageal localization (HR: 3.398, p = 0.042), low hemoglobin levels (HR: 0.758, p = 0.030), and high Glasgow- Blatchford score (HR: 1.179, p = 0.035) were associated with rebleeding. Duodenal localization was independently associated with higher mortality (HR: 27.276, p < 0.001), after adjusting for age, sex, and comorbidity index. Dieulafoy lesions are most commonly found in the stomach but can also occur in atypical sites like the jejunum or hernia pouch. Enteroscopy is crucial for diagnosing and treating DLs, especially those in atypical small intestine locations. Lesion localization plays a key role in predicting both rebleeding and mortality rates.

Dieulafoy's lesion is a rare but potentially life-threatening gastrointestinal condition that often requires endoscopic management. However, there is a lack of consensus on the optimal endoscopic intervention for this condition. This meta-analysis aimed to compare the efficacy and safety of endoscopic mechanical interventions versus endoscopic injection interventions in the treatment of Dieulafoy's lesion. A systematic literature search was conducted using PubMed, Google Scholar pages 0-20 and Cochrane Library databases to identify relevant studies published up to March 2023. Studies comparing the outcomes of endoscopic mechanical and injection interventions for Dieulafoy's lesion were included. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random or fixed effects model depending on the heterogeneity I 2 value. A total of seven comparative studies were included in the meta-analysis consisting of three clinical trials and four retrospective studies. The clinical outcomes consisted of the initial hemostasis, as well as adverse events: recurrent bleeding, death and the need for an operation. It was shown that endoscopic injection therapy was associated with a lower risk of recurrent bleeding in the treatment of Dieulafoy's lesion compared to mechanical therapy (95% CI, OR=0.33 [0.16, 0.69] , p-value=0.003). However, there were no significant differences between mechanical and injection techniques in terms of initial hemostasis, death, or need for an operation. Our findings suggest that injection methods may be preferred over mechanical techniques in the management of Dieulafoy's lesion due to its potential to reduce recurrent bleeding. Although it is a simple and a non-expensive technique, further studies are needed to confirm these findings and evaluate the long-term outcomes of both interventions.

Dieulafoy’s ulcer is a rare but potentially life, threatening vascular anomaly of the gastrointestinal tract. It is characterized by the erosion of the wall of a submucosal artery, most commonly in the stomach, though it can also occur elsewhere along the digestive tract. While the gastric location is most frequently reported, extragastric cases, particularly in the small intestine, have also been described. This lesion is often associated with significant gastrointestinal bleeding, which may be severe or even fatal. Prompt diagnosis is essential to ensure appropriate therapeutic intervention, usually endoscopic, and to prevent serious complications such as perforation or massive hemorrhage. We present a rare case of Dieulafoy’s ulcer located in the duodenum, an uncommon site, and discuss the diagnostic and therapeutic challenges it poses, as well as its relevance in the management of gastrointestinal bleeding.

Dieulafoy’s lesion (DL) is a rare but significant cause of gastrointestinal bleeding, typically found in the stomach along the lesser curvature. Reports of DL at surgical anastomosis sites are rare, with to our knowledge no documented cases involving a gastro-colonic anastomosis. We report the case of a 65-year-old female with a history of esophagectomy, chronic hemodialysis and rheumatoid arthritis, who presented with hematemesis, melena, and epigastric pain. gastroscopy revealed a postsurgical gastro-colic anastomosis harboring a 5-mm Dieulafoy lesion. Hemostasis was successfully achieved using epinephrine injection and hemostatic clips. The patient’s recovery was uneventful. This case represents to our knowledge the first reported instance of a Dieulafoy lesion at a gastro-colonic anastomosis site. The rarity of this presentation emphasizes the importance of considering DL in differential diagnoses of gastrointestinal bleeding in patients with complex surgical anatomy. Endoscopic intervention remains the cornerstone of diagnosis and treatment, with mechanical hemostasis offering high success rates. Early recognition and prompt endoscopic management are also crucial for favorable outcomes.

Diagnosis of massive obscure gastrointestinal bleeding from a Dieulafoy lesion identified by intraoperative enteroscopy.

Our aim is to describe a rare etiology of an upper gastrointestinal bleeding (UGIB) to help pediatric emergency medicine clinicians improve their understanding of its presentation as well as the standard therapeutic approach to UGIB. This is a retrospective case report of a patient who presented to the Pediatric Emergency Department of Hasbro Children's Hospital and who was found to have a UGIB secondary to a Dieulafoy lesion. The etiology of UGIBs varies by geography and patient age but includes esophagitis, Mallory-Weiss tears, gastritis, peptic ulcers, and foreign body ingestion. Given the overlapping presenting symptoms, history and physical are critical to identifying likely etiology and guiding treatment. This patient improved after definitive treatment with endoscopy and hemo-clips. Children with symptoms of UGIB should receive prompt resuscitation and stabilization, and clinicians should maintain an index of clinical suspicion for less common pediatric pathologies, such as malignancy or arterial bleeding.

Abstract Background Dieulafoy lesions account for 1-2% of acute GI bleeding and can be difficult to treat endoscopically. Aims We present a case a 59-year-old male who presented with hematemesis, melena, and hemodynamic instability. Methods Initial esophago-gastro-duodenoscopies (EGD) did not detect a source of active bleeding. Abdominal CT angiography revealed vascular structure in the stomach’s greater curvature, indicating a Dieulafoy lesion. Embolization via interventional radiology was unsuccessful. A third EGD finally showed the bleeding as a focal ooze localized in the proximal part of the greater curvature of the stomach. We used a padlock over-the-scope clip (OTSC). Despite successful deployment and placement of the OTSC, the bleeding persisted. Results Ultimately, hemostasis was achieved using five through-the-scope clips in a zipper fashion to the mound of tissue that had been raised by the over the scope clip. We hypothesize that although the OTSC grasped the Dieulafoy lesion, the feeding vessels were not significantly compressed to achieve hemostasis. This case demonstrates the failure of an OTSC to control bleeding from a Dieulafoy lesion, which was ultimately managed with through-the-scope clips. Conclusions This underscores the importance of combining traditional and novel endoscopic techniques to achieve hemostasis. Funding Agencies None