Recurrent Digestive Bleeding: The Essential Is Invisible To The Eyes

A 58-year-old woman presented with melena and a hemoglobin of 10.6 g/dL. Esophagogastroduodenoscopy (OGD), colonoscopy and capsule endoscopy were unremarkable. Three weeks later, she was readmitted due to hematochezia and lipothymia. Abdominopelvic Angio-CT highlighed an 8 mm hypervascular nodular image in the duodenal bulb, originating from the gastroduodenal artery. Duodenoscopy revealed a protruding lesion with a central erosion, located on the upper wall of the bulb, immediately distal to the pylorus. Attempted hemostasis with hemoclips failed due to unfavourable endoscopic access and resulted in intermittent pulsatile bleeding. The patient underwent sucessful endovascular embolization of the Dieulafoy’s lesion with coils.