Life-threatening bleeding from gastric dieulafoy's lesion in a pregnant woman with hellp syndrome: a case report and literature review

BMC Gastroenterol. 2017 Jul 31;17(1):89. doi: 10.1186/s12876-017-0646-1.

Abstract

Background: Dieulafoy's lesion (DL) is one of the rare causes of upper gastrointestional bleeding. This disease is characterized by small sub-mucosal arteriole that eroded the stomach mucosa and cause severe upper GI bleeding without obvious ulceration. The most common location is fundus area of stomach and usually affects patients over 50 years of age with multiple comorbidities.

Case presentation: We report a case of life-threatening bleeding from DL during late pregnancy 31 weeks. Hemoclips were used twice through upper endoscopy with successful hemostasis. Unfortunately, she developed HELLP syndrome diagnosed 5 days after the GI bleeding was stopped. Her pregnancy had to be terminated with delivery of a premature infant. She recovered from her illness and discharged from hospital uneventfully. There is no current report in literature of DL in pregnant woman subsequently suffered HELLP syndrome.

Conclusion: Endoscopic hemoclip application is an effective technique in the treatment of upper GI bleeding from DL. For this patient, laparoscopic surgery or combination therapy before pregnancy may have been a suitable treatment on preventing rebleeding.

Keywords: Dieulafoy’s lesion; HELLP syndrome; Pregnancy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Female
  • Gastric Mucosa / blood supply
  • Gastrointestinal Hemorrhage / etiology*
  • Gastrointestinal Hemorrhage / therapy
  • HELLP Syndrome / etiology*
  • Humans
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / etiology*
  • Pregnancy Complications, Cardiovascular / therapy
  • Stomach Diseases / complications*
  • Stomach Diseases / therapy
  • Vascular Diseases / complications*
  • Vascular Diseases / therapy