Complex Presentation of a Dieulafoy Lesion in a Geriatric Patient with Multiple Comorbidities

Dieulafoy lesions (DL) consist of tortuous, thick-walled submucosal arteries that protrude through a small mucosal defect, often surrounded by otherwise normal mucosa. They are commonly located in the proximal stomach, particularly along the lesser curvature and near the esophagogastric junction, ty...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-10, Vol.15 (10)
Main Authors: Alfroukh, Khadeejeh, Janajri, Mohammed E, Mikkawi, Aya E, Bairmani, Zinah, Salah, Qais M, Dawoud, Abdallatif M, MohammedAli, Majdeddin, Abuturki, Abdelwadod A, Al-Rajabi, Aref
Format: Article
Language:English
Subjects:
Anticoagulants
Asthma
Blood pressure
Cardiac arrhythmia
Case reports
Comorbidity
Emergency Medicine
Endoscopy
Etiology
Gastroenterology
Heart failure
Hematemesis
Hemoglobin
Hypertension
Internal Medicine
Leukocytes
Mortality
Older people
Pulmonary arteries
Surgical anastomosis
Ultrasonic imaging
Veins & arteries
Vital signs
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Summary:Dieulafoy lesions (DL) consist of tortuous, thick-walled submucosal arteries that protrude through a small mucosal defect, often surrounded by otherwise normal mucosa. They are commonly located in the proximal stomach, particularly along the lesser curvature and near the esophagogastric junction, typically within 5 cm. However, they can also occur in various other regions of the GI tract, including the esophagus, duodenum, and colon. We present the case of a 76-year-old female with a complex medical history who arrived at the ED with hematemesis and melena. Her condition rapidly deteriorated; her blood pressure significantly dropped. Upon stabilization, upper endoscopy uncovered a 5-cm red lesion near the gastroesophageal junction, indicative of DL. Immediate intervention with clips was successful. Following the procedure, while the patient was in the ICU, she started to experience left-sided chest pain and diaphoresis, leading to the suspicion of acute coronary syndrome. Further investigations revealed non-ST-elevation myocardial infarction (NSTEMI). This case highlights the life-threatening nature of upper GI bleeding, especially in elderly patients with multiple comorbidities and extensive medication regimens. Timely diagnosis and intervention for DL are crucial, particularly in elderly patients with multiple health comorbidities. This underscores the significance of prompt medical attention and intervention in such complex scenarios.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.47985