title: Dieulafoy lesion in a two-year-old boy: a case report.
abstract: BACKGROUND
  Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping.
  
  
  METHODS
  A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis. He had no significant past medical illness, and he was well just before the episode of hematemesis. A clinical examination revealed anemia (hemoglobin, 8.0 g/dl). The rapidly progressive anemia associated with massive hematemesis indicated the presence of an active bleeding in his upper gastrointestinal tract. We performed emergency gastroscopy under general anesthesia. The gastroscopy revealed the presence of an abnormal visible vessel with an adherent clot on the lower body of his stomach. No mucosal abnormality surrounding the lesion was noted; the lesion was thus diagnosed as Dieulafoy lesion. One hemostatic clip was placed on the Dieulafoy lesion and excellent hemostasis was obtained. He recovered without blood transfusion and was discharged 4 days post-endoscopy. He has recovered well with no recurrence of hematemesis.
  
  
  CONCLUSIONS
  Dieulafoy lesion is rare cause of sudden massive gastrointestinal bleeding in children. Nevertheless, it should be considered a differential diagnosis, even in babies. With advances in gastrointestinal endoscopy, as both a diagnostic and therapeutic modality, laparotomy secondary to gastrointestinal bleeding from Dieulafoy lesion has decreased in pediatric cases. Our case report demonstrates the feasibility of endoscopic hemoclipping for gastric Dieulafoy lesion in a child.
authors.affiliation: Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan. emura-ygt@umin.ac.jp.
authors.forename: Takaki
authors.identifier: http://orcid.org/0000-0002-1170-4412
authors.initials: T
authors.lastname: Emura
authors.affiliation: Department of Gastrointestinal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hosoda
authors.affiliation: Department of Gastrointestinal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan.
authors.forename: Shota
authors.initials: S
authors.lastname: Harai
authors.affiliation: Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Oyachi
authors.affiliation: Department of Pediatric Surgery, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, 400-8506, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takada
authors.affiliation: Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Pediatrics, Yamanashi Kosei Hospital, 860 Ochiai, Yamanashi, 405-0033, Japan.
authors.forename: Hisatake
authors.initials: H
authors.lastname: Ikeda
mesh_terms: D000208:Acute Disease; D001158:Arteries / Q000002:abnormalities*; D002675:Child, Preschool; D005773:Gastroscopy; D006396:Hematemesis / Q000209:etiology*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors; D011859:Radiography; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging; D013272:Stomach Diseases / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D054328:Proton Pump Inhibitors
keywords: Child; Dieulafoy; Endoscope; Gastrointestinal bleeding; Hemostasis; Infant