Massive Hematemesis from Gastric Dieulafoy's Lesion, Surgery as a Curative Option When There is Lack of Access to Expertise

Abstract

Dieulafoy’s lesion is an acute GI (gastrointestinal) bleeding disorder, a rare but life-threatening condition due to recurrent bleeding. The affected arteriole can protrude through a small defect in the mucosa, becomes susceptible to the mechanical trauma even of a minor level and gradually erodes into the lumen to cause severe acute GI bleeding.  A 40-year-old married woman was admitted with a history of massive hematemesis for 17 days. A series of 3 upper GI endoscopies were done, and the patient was diagnosed with Dieulafoy’s lesion. Local epinephrine via EGD failed to stop hematemesis following which surgical consultation was duly referred. Exploratory laparotomy was done that showed a lesion near the lesser curvature. The lesion was ligated with under-run suturing. Surgical intervention was selected on the basis of lesion's presentation and clinical aspects of the patient.  Surgical intervention remains a better choice in case of massive hematemesis in a setting where the access to the availability of expertise is low.