Dieulafoy's Lesion

Even more bleeding

Step 1: View clinicals

A 28 year old woman presents with dizziness, lightheadedness, and mild exertional dyspnea for two days. She also experienced an episode of coffee ground vomitus and melena earlier today. She does not smoke or drink, is not on any drugs, and has an unremarkable medical history.


Step 2: Order all relevant investigations

Full Blood Count

WBC/DC: 7,200/mm3 Hb: 4.3 g/dL Platelets: 280,000/mm3

Upper GI Endoscopy

The esophagus appears normal. There is an active, pulsatile bleeding point in the gastric fundus. No ulcers are seen in the stomach or duodenum.

Renal functions

Urea: 56 mg/dl (0 - 50) S. Creatinine: 0.5 mg/dl (< 1.5) Urea:Creatinine Ratio: 112 (<100)

Colonoscopy

No colonic lesions are identified.


Step 3: Select appropriate management

Packed RBCs
Vitamin K
Endoscopic Banding
Beta Blockers


Score: ★★☆