title: Dieulafoy lesion of the gallbladder presenting with bleeding and a pseudo-mirizzi syndrome: A case report and review of the literature.
abstract: BACKGROUND
  Gastrointestinal bleeding can have significant morbidity and mortality. Pathological processes that cause it are diverse, and timely investigation and management are vital. Dieulafoy lesions are a rare cause of gastrointestinal bleeding and here we describe a case of a gallbladder dieulafoy lesion causing gastrointestinal bleeding.
  
  
  METHODS
  Recently discharged from hospital following an open anterior resection and loop ileostomy for diverticular disease, an 84-year-old female re-presented with lower abdominal pain associated with jaundice and lymphocytosis. Imaging demonstrated two possible rectal stump collections (treated with antibiotics), and heterogeneous material in the gallbladder. The patient deteriorated, developing melena, coffee ground vomitus and right upper quadrant pain. Investigation sourced the bleeding to the gallbladder that resolved following cholecystectomy, and histopathology was consistent with a dieulafoy lesion. The patient made a full recovery.
  
  
  CONCLUSIONS
  Dieulafoy lesions have rarely been reported in the gallbladder, and as such can be an occult source of massive gastrointestinal bleeding. It should be considered where gastrointestinal bleeding accompanies jaundice and abdominal pain.
  
  
  CONCLUSIONS
  This case highlights that dieulafoy lesions can occur in the gallbladder. Massive gastrointestinal bleeding can occur within the gallbladder, and a gallbladder dieulafoy lesion should be considered as a potential cause of such, especially when a source has not been identified on endoscopy. It also demonstrates the effectiveness of cholecystectomy as a definitive management strategy.
authors.affiliation: Eastern Health Surgical Research Group, Monash University, Eastern Health Clinical School, 5 Arnold St, Box Hill, Melbourne, Victoria 3128, Australia. Electronic address: aaron.stanes1990@gmail.com.
authors.forename: Aaron
authors.initials: A
authors.lastname: Stanes
authors.affiliation: Eastern Health Surgical Research Group, Monash University, Eastern Health Clinical School, 5 Arnold St, Box Hill, Melbourne, Victoria 3128, Australia. Electronic address: sean.mackay@monash.edu.
authors.forename: Sean
authors.initials: S
authors.lastname: Mackay
keywords: Cholecystectomy; Dieulafoy; Gallbladder; Gastrointestinal bleeding; Haemobilia