DOI: 10.36347/sjmcr.2018.v06i09.026

Pages: 703-705

Dieulafoy's lesion is a rare etiology of recurrent gastrointestinal (GI) bleeding and periampullary location is very uncommon for a bleeding Dieulafoy's lesion. Endoscopy is the current standard method for diagnosis and treatment but difficult to diagnose when bleeding is inactive. A case of a sixteen-year old male patient was presented with recurrent massive upper GI bleed. Multiple endoscopic findings were unremarkable and angiography showed dilatation of gastroduodenal artery but no sign of active bleeding. Endoscopy was repeated during active bleeding and it showed bleeding periampullary Dieulafoy's lesion but failed endoscopic hemostasis. Ultimately, hemostasis was achieved by transcatheter arterial embolisation (TAE) of gastroduodenal artery. Thus, periampullary Dieulafoy's lesion represents a diagnostic and therapeutic challenge for clinicians.