Double Dieulafoy's lesions of the stomach in a patient with chronic renal failure on long-term hemodialysis.

ABSTRACT

Dieulafoy's lesions are an uncommon cause of major gastrointestinal hemorrhage; they occur after rupture of an exposed submucosal artery. Despite widespread awareness of this entity, the lesion remains a diagnostic challenge because of its small size and hidden location. Dieulafoy's lesions may be associated with immunosuppression, hemodynamic disorders and the vascular compromise that occurs after long-term hemodialysis. However, there are no data comparing the incidence of Dieulafoy's lesions in patients with chronic renal failure to that in controls. Dieulafoy's lesions have been reported in patients with chronic renal failure, but are extremely rare. Furthermore, there are no prior reports on double lesions in the stomach. This is the first report of simultaneous double Dieulafoy's lesions of the stomach diagnosed after the seventh upper gastrointestinal endoscopy and massive transfusions in a 70-year-old woman with chronic renal failure on long-term hemodialysis. These lesions were successfully treated by successive endoscopic band ligations.