Duodenal dieulafoy's lesion
Metadata[+] Show full item record
Case: A 92-year-old female presented to hospital with one week history of black tarry stools that was associated with generalized weakness and fatigue. She denied dizziness, hematemesis, hematochezia, or abdominal pain. She had medical history of myelodysplastic syndrome, gastro-esophageal reflux disease, and hypertension. On admission, she was hemodynamically stable, her physical exam was unremarkable. Initial Hgb was noted to be 5.7 g/dL with baseline Hgb of 9.0 g/dL. Her chemistry was notable for elevated BUN of 40 mg/dL and creatinine of 1.0 mg/dL. Her INR and platelet counts were normal. She was given intravenous proton pump inhibitor and two units of packed red blood cells. Following initial medical treatment, an urgent upper endoscopy was performed, which demonstrated an actively spurting visible vessel in duodenal sweep with normal surrounding mucosa consistent with Dieulafoy's lesion (DL) (Figure 1). A complete hemostasis was achieved with dual therapy of sub-mucosal epinephrine injection, followed by deployment of seven hemoclips (Figure 2). Post-procedure Hgb remained stable at 8.5 g/dL and subsequently, she was discharged home after 3-days of hospital stay
Am j Hosp Med 2021 June;5(2):2021
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.