Biography
Pedro López completed his MD in the University of Puerto Rico, Medical Sciences Campus in San Juan, PR. He is currently completing residency in the internal medicine program of the University District Hos pital which is affiliated to the University of Puerto Rico, Medical Sciences Campus.
Introduction
Dieulafoy’s Lesion (DL) is an abnor mally dilated and aberrant submucosal artery that crodes the overlying epithelium of the gastrointestinal tract. It is commonly located in the stomach, although it can be found in other areas of the gastrointestinal tract. DL. can cause severe and sudden gastrointestinal bleeding and is an important diagnostic consideration when evaluating a patient with persistent gastrointestinal bleeding.
A 55-year-old male patient presented to the emergency department (ED) for suture removal of a head laceration after suffering a motor vehicle accident two weeks prior Accident resulted in bowel contusion without complice- tions for which he was discharged to home by the trauma team. During triage the patient was found pale, tachy cardic and tachypneic. He was placed under cardiac moni tor surveillance. While workup was underway, he had a sudden outburst of large melena episode followed by mul- tiple episodes of hematochezia. Patient developed hemo- dynamic instability and respiratory failure, requiring me chanical ventilation. Initial hemoglobin (Hb) levels were reported at 4.1 g/dl. Massive transfusion protocol started along with vasopressor support with Levophed and Vaso- pressin. Patient was initiated in high dose PPI with Panto prazole 40mg IV q12hr and Octreotide infusion. Emer gency endoscopic evaluation was performed and active arterial pumping was noted at the proximal aspect of the corpus of the stomach concerning for a Dieulafoy’s lesion, which was managed with endoscopic clipping. No further episodes of gastrointestinal bleeding reported afterwards, Hb became stable and the patient clinically improved.
Dieulafoy’s lesion has been documented as the culprit of 1-2% of acute gastrointestinal bleeding, however its prevalence is underestimated due to lack of awareness regarding this lesion. The etiology is unclear, but it is thought to be congenital. To our knowledge, this is the first case reported in medical literature in a post trauma patient presenting with gastrointestinal bleeding caused by Dieulafoy’s lesion.