Upper digestive hemorrhage secondary to major duodenal papilla Dieulafoy’s lesion: Case report





Gastrointestinal Hemorrhage ; Endoscopy; Ampulla of Vater.


Introduction: Dieulafoy’s lesion (DL) is occasioned by a tortuous, persistent and large caliber artery that emerges the mucosa from the submucosa of an organ, eventually triggering gastrointestinal bleeding in the presence of eroding factors of the mucosa and arterial wall. The presence of DL has been described in many anatomic topographies and although it predominates in the upper digestive tract, the presence of this lesion exactly in the major duodenal papilla is a rare event. Objective: to report a case of upper gastrointestinal bleeding secondary to a major duodenal papilla DL. Case report: a 72 year-old female, admitted to hospital care with a clinical history of two months continuous, painless melena, multiple previous blood transfusions and symptomatic anemia. She was referred by another health service with the diagnostic hypothesis of hemobilia, suggested by two previous esophagogastroduodenoscopies. Her abdominal ultrasound and arteriography were normal. A third esophagogastroduodenoscopy evidenced active bleeding in the duodenal major papilla, and after a carefully analysis a papillar DL was diagnosed. It was treated by endoscopy with adrenaline 1:10000 injection and thermocoagulation. Following this procedure she evolved with severe acute pancreatitis due to papillitis and need of intensive care unit admission. No rebleeding was detected and hospitalar discharge occurred twenty days after hospitalization. Conclusion: The localization of a DL at the major papilla is a rare event and acute pancreatitis is a complication related to its endoscopic treatment.


Baxter, M., & Aly, E. H. (2010). Dieulafoy’s Lesion: current trends in diagnosis and management. Annals of the Royal College of Surgeons of England, 92(7), 548-554.

Bilal, M., Kapetanos, A., Khan, H. A., & Thakkar, S. (2015). Bleeding “Dieulafoy’s-Like” lesion resembling the duodenal papilla: a case report. Journal of Medical Case Reports, 9(1), 118.

Han, S., Wagh, M. S., & Wani, S. (2021) The rare finding of a Dieulafoy’s lesion at the major papilla. Endoscopy. 53(2), E44-E45.

He, Z.W., Zhong, L., Xu, H., Shi, H., Wang, Y.M., & Liu, X. C. (2020). Massive gastrointestinal bleeding caused by a Dieulafoy’s lesion in a duodenal diverticulum: a case report. World Journal of Clinical Cases, 8(20), 5013-5018.

Ibrarullah, M., & Wagholikar, G. D. (2003). Dieulafoy’s lesion of duodenum: a case report. BMC Gastroenterology, 3(1), 2.

Inayat, F., Amjad, W., Hussain, Q., & Hurairah, A. (2018). Dieulafoy’s lesion of the duodenum: a comparative review of 37 cases. BMJ case reports, 2018, 1-6.

Khan, R., Mahmad, A., Gobrial, M., Onwochei, F., & Shah, K. (2015) The Diagnostic Dilemma of Dieulafoys Lesion. Gastroenterology Research. 8(3-4).

Lai, Y., Rong, J., Zhu, Z., Liao, W., Li, B., Zhu, Y., Youxiang C., & Shu, X. (2020). Risk factors for rebbleding after emergency endoscopic Treatment of Dieulafoy Lesion. Canadian Journal of Gastroenterology and Hepatology, 2020(1), 1-8.

Lim, W., Kim, T. O., Park, S. B., Rhee, H. R., Park, J. H., Bae, J. H., Jung, H. R., Kim, M. R., Lee, N., Lee, S. M., Kim, G. H., Heo, J., & Song, G. A. (2009). Endoscopic treatment of Dieulafoy Lesions and Rinsk factors for rebleeding. The Korean Journal of Internal Medicine, 24(4), 31-322.

Malliaras, G. P., Carollo, A., & Bogen, G. (2016). Esophageal Dieulafoy’s lesion: an exceedingly rare cause of massive upper GI bleeding. Journal of Surgical Case Reports, 6, 1-2.

Massinha, P., Cunha, I., & Tomé, L. (2020). Dieulafoy Lesion: Predictive Factors of Early Relapse and Long-Term Follow-up. Portuguease Journal of Gastroenterology, 27(4), 237-243.

Murali, U., Ahmad, M. A. A., Hali, A. R. B. A., & Hamidin, M. A. (2017). Melena secondary to Duodenal Dieulafoy’s Lesion: A rare case report. Journal of Clinical and Diagnostic Research, 11(11), PD06-PD08.

Nguyen, D. C., & Jackson, C. S. (2015). The Dieulafoy’s Lesion: an update on evaluation, diagnosis and Management. Journal of Clinical Gastroenterology, 49(7), 541-549.

Nojkov, B., & Cappell, M. S. (2015). Gastrointestinal bleeding from Dieulafoys lesion: Clinical presentation, endoscopic findings, and esdoscopic therapy. World Journal of Gastrointestinal Endoscopy, 7(4), 295-307.

Oladunjoye, O., Oladunjoye, A., Slater, L., & Jehangir, A. (2020). Dieulafoy lesion in the jejunum: a rare cause of massive gastrointestinal bleeding. Journal of Community Hospital Internal Medicine Perspectives, 10(2), 138-139.

Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. UFSM. https://repositório.ufsm.br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa-Científica.pdf?sequence=1.

Rana, S. S., Bhasin, D. K., Gupta, R., Yadav, T. D., Gupta, V., & Singh, K. (2010). Periampulary Dieulafoy’s Lesion: an unusual cause of gastrointestinal bleeding. Journal of the Pancreas, 11(3), 266-269.

Reilly H. F., & Al-Kawas F.H. (1991). Dieulafoy’s Lesion. Diagnoses and management, Digestive Diseases and Sciences, 36(12), 1702-1707.

Stojakov, D., Velicković, D., Sabljak, P., Bjelović, M., Ebrahimi, K., Spika, B., Sljukić, V., & Pesko, P. (2007). Dieulafoy’s lesion: rare cause of massive upper gastrointestinal bleeding. Acta Chirurgica Iugoslavica, 54(1):125-129.

Wang, M., Bu, X., Zhang, J., Zhu., S., Zheng, Y., Tantai, X., & Ma, S. (2017). Dieulafoy’s lesion of the rectum: a case report and review of the literature. Endoscopy International Open, 05, E939-E942.




How to Cite

LIMA, S. N. P. .; RIBEIRO, D. A. B. .; GIRELI, L. P. de O. .; FARIA, L. D. de C. .; MARTINS, G. da S. . Upper digestive hemorrhage secondary to major duodenal papilla Dieulafoy’s lesion: Case report . Research, Society and Development, [S. l.], v. 10, n. 9, p. e22710918093, 2021. DOI: 10.33448/rsd-v10i9.18093. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/18093. Acesso em: 20 sep. 2021.



Health Sciences