Periampullary Dieulafoy's lesion: an unusual cause of gastrointestinal bleeding.
BACKGROUND
Dieulafoy's lesion is an unusual cause of gastrointestinal bleeding with the most common location being the stomach. A periampullary location is rare for a bleeding Dieulafoy's lesion.


METHODS
We present the case of a 52-year-old female who presented with intermittent painless melena. Her upper gastrointestinal endoscopy and colonoscopy were normal. She was a diagnostic challenge as no definite lesion could be identified on capsule endoscopy. However, as there was presence of fresh blood in the proximal jejunum, a push enteroscopy was performed which revealed the presence of fresh blood in the duodenum and proximal jejunum. But no bleeding lesion could be identified. A side view endoscopy was performed which revealed a bleeding periampullary Dieulafoy's lesion. Immediate hemostasis was achieved with an injection of adrenalin. Other episodes of bleeding occurred and the patient was finally treated surgically.


CONCLUSIONS
A periampullary Dieulafoy's lesion presenting with obscure gastrointestinal bleed is a diagnostic challenge and can be missed on capsule endoscopy.
Rana
Surinder S
SS
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12. Chandigarh, India. drsurinderrana@yahoo.co.in
Bhasin
Deepak K
DK
Gupta
Rajesh
R
Yadav
Thakur Deen
TD
Gupta
Vivek
V
Singh
Kartar
K
D014670:Ampulla of Vater; D000783:Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging*; D000792:Angiography; D053704:Capsule Endoscopy; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007583:Jejunum / Q000098:blood supply*; D008875:Middle Aged; D013152:Splanchnic Circulation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D014662:Vasoconstrictor Agents; D004837:Epinephrine