title: Bleeding "Dieulafoy's-like" lesion resembling the duodenal papilla: a case report.
abstract: BACKGROUND
  Dieulafoy's lesion is an uncommon but important cause of gastrointestinal bleeding in which hemorrhage occurs from a pinpoint, non-ulcerated arterial lesion. DLs are usually located in the stomach, most commonly in people between the ages of 50 and 70 years. In this report, we describe a teenage patient with an unusual presentation of a bleeding duodenal Dieulafoy's-like lesion that resembled the duodenal papilla.
  
  
  METHODS
  An 18-year-old Pakistani woman presented to our emergency department with hematemesis of 6 hours' duration. Her past medical history was unremarkable. A nasogastric aspirate was negative for blood. The patient's hemoglobin was found to be 4 g/dl. She was resuscitated with intravenous fluids and blood transfusion. An esophagogastroduodenoscopy was performed, which revealed swelling in the first part of the duodenum, the initial appearance of which suggested that it was an abnormally placed or accessory papilla. There was a small, <3-mm opening on the lesion that resembled the biliary or pancreatic orifice. On gentle manipulation with a catheter, blood spurted from the swelling area, and a vessel was visible. Adrenaline was used for hemostasis. After hemostasis was achieved, it became clear that the lesion was most consistent with a Dieulafoy's-like lesion and not a papilla. Band ligation was then performed, and the patient did not develop any complications and did not have any further episodes of bleeding. The patient was eventually discharged to home in stable condition.
  
  
  CONCLUSIONS
  This case report highlights the importance of considering a DL as a cause of small-bowel hemorrhage and recognizing its potential resemblance to the papilla. Although the endoscopic diagnostic criteria for a Dieulafoy's lesion have been described in great detail, there is a paucity of literature describing a Dieulafoy's lesion or a similar lesion resembling the duodenal papilla.
authors.affiliation: Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA. mbilal@wpahs.org.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Bilal
authors.affiliation: Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA. akapetan@wpahs.org.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kapetanos
authors.affiliation: Center for Liver and Digestive Diseases, Holy Family Hospital, Satellite Town, Rawalpindi, 46000, Pakistan. haider1323@gmail.com.
authors.forename: Haider Ali
authors.initials: HA
authors.lastname: Khan
authors.affiliation: Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA. sthakkar@wpahs.org.
authors.forename: Shyam
authors.initials: S
authors.lastname: Thakkar
mesh_terms: D000293:Adolescent; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000098:blood supply* / Q000601:surgery; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006396:Hematemesis / Q000209:etiology; D016558:Hemostasis, Endoscopic; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply*; D014652:Vascular Diseases / Q000150:complications / Q000175:diagnosis
chemical_list: D004837:Epinephrine