Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 5013-5018
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.5013
Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: A case report
Zhi-Wei He, Ling Zhong, Hui Xu, Hua Shi, Yang-Mei Wang, Xiao-Cong Liu
Zhi-Wei He, Ling Zhong, Hui Xu, Hua Shi, Yang-Mei Wang, Department of Gastroenterology and Hepatology, Ziyang First People’s Hospital, Ziyang 641300, Sichuan Province, China
Xiao-Cong Liu, Department of Gastroenterology and Hepatology, Chengdu Second People's Hospital, Chengdu 610017, Sichuan Province, China
Author contributions: He ZW performed the endoscopy examination; Zhong L performed the endoscopic treatment; Xu H provided guidance during the treatment process; Shi H and Wang YM assisted during the treatment process; Liu XC acquired all data and wrote the manuscript.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest associated with this study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Cong Liu, MD, PhD, Attending Doctor, Department of Gastroenterology and Hepatology, Chengdu Second People's Hospital, No. 10 South Qingyun Street, Chengdu 610017, Sichuan Province, China. xiaocongliu1981@yeah.net
Received: June 22, 2020
Peer-review started: June 22, 2020
First decision: July 28, 2020
Revised: July 30, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 26, 2020
Processing time: 125 Days and 19.6 Hours
Abstract
BACKGROUND

Dieulafoy’s lesion is a rare vascular abnormality characterized by a small abnormally dilated artery that runs a tortuous course in the submucosa. There is usually no ulcer present in Dieulafoy’s lesions and the overlying mucosa is most often normal. Bleeding caused by a Dieulafoy’s lesion is usually urgent, massive, life-threatening and prone to recurrence. Dieulafoy’s lesions have been reported throughout the digestive tract although the majority of them have been found in the upper digestive tract especially the stomach and duodenum. However, a Dieulafoy’s lesion occurring inside a duodenal diverticulum is very rare.

CASE SUMMARY

A 74-year-old Asian male with epigastric pain, hematemesis and melena was admitted to our clinic. Before admission, the patient had vomited 500 mL of dark red blood, and passed 200 g of black tarry stool. Conservative management was first undertaken as the patient had not been fasting. However, hemorrhage recurred and the patient went into shock. Urgent endoscopy was performed and a diverticulum of 1.8 cm × 1.2 cm × 0.8 cm was found on the anterior wall of the descending duodenum. The diverticulum was covered with a blood clot. After the clot was removed, an artery stump was observed in the diverticulum with a diameter of 2-3 mm. Two titanium hemostatic clips were inserted to clamp the vessel stump. The patient was discharged 7 d post-endoscopy and followed for 6 mo with no recurrence.

CONCLUSION

This case was diagnosed with a Dieulafoy’s lesion inside a duodenal diverticulum which has rarely been reported. Hematemesis was stopped by clamping the vessel stump with titanium clips. No complications occurred.

Keywords: Dieulafoy’s lesion; Duodenal diverticulum; Gastrointestinal bleeding; Endoscopy; Hemostatic clip; Case report

Core Tip: Dieulafoy’s lesion is a rare vascular abnormality characterized by a small artery with an abnormally dilated caliber that runs a tortuous course in the submucosa. Bleeding caused by a Dieulafoy’s lesion is frequently urgent and massive, prone to recurrence, and life-threatening. Dieulafoy’s lesions have been reported throughout the digestive tract, but have rarely been reported inside a duodenal diverticulum.