Massive Upper Gastrointestinal Bleeding in an Adolescent Patient: A Case Report.
Thomas Leith, Anjali Rajkumari Oberoi, T Matthew Shields et al.
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Case in brief
A 17-year-old boy with plaque psoriasis presented with copious hematemesis and hemodynamic instability. He received blood transfusion and was admitted to the pediatric intensive care unit. Initial upper endoscopy showed a duodenal erosion, but this finding did not account for continued large-volume bleeding. Repeat endoscopy identified a Dieulafoy lesion, which was treated successfully. He was discharged home and remained stable during long-term follow-up.
What made this case unusual
The initial endoscopy found a duodenal erosion, while a subsequent examination revealed a separate Dieulafoy lesion that better explained the ongoing severe bleeding.
Diagnostic / clinical pearl
When bleeding continues out of proportion to initial endoscopic findings, consider an additional source and the limitations of a single examination; further endoscopic evaluation may identify a treatable lesion.