Refractory Duodenal Dieulafoy Lesion Requiring Surgical Intervention in a Lung Transplant Candidate: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Dieulafoy lesions are rare vascular malformations accounting for 1.0-6.5% of gastrointestinal bleeding (GI) cases, characterized by an abnormally dilated submucosal artery that erodes through the mucosa without primary ulceration. While endoscopic intervention achieves hemostasis in approximately 90% of cases, rebleeding rates range from 6-45% depending on techniques implemented. Risk factors associated with rebleeding include current use of anticoagulation, leukocytosis, and medical comorbidities, including cardiovascular disease, tobacco use, and diabetes mellitus. We present a case of a duodenal Dieulafoy lesion refractory to endoscopic and angiographic intervention, thus necessitating surgical resection in a critically ill patient awaiting lung transplantation, highlighting the challenges of managing persistent GI hemorrhage in complex patients who require anticoagulation.

The patient is a 65-year-old male with type 2 diabetes, tobacco use, coronary artery disease, and interstitial lung disease (ILD) on 2-3L oxygen at baseline. He initially presented with dyspnea and hemoptysis, and was found to have an ILD exacerbation with superimposed necrotizing pneumonia requiring prolonged mechanical ventilation and tracheostomy. Due to progressive pulmonary fibrosis and inability to wean off the ventilator, the patient was considered for lung transplantation. However, while awaiting medical stability, his hospital course was further complicated by acute decompensation necessitating VV-ECMO, as well as multiple deep vein thromboses with bilateral pulmonary emboli. After initiation of anticoagulation, the patient became intermittently hypotensive and anemic (Hgb 5.7), thus requiring vasopressors and repeated blood transfusions. CT angiography was unable to identify a bleeding source; however, the patient developed melena and so Gastroenterology was promptly engaged.

This case demonstrates that duodenal Dieulafoy lesions in anticoagulated, critically ill patients represent a challenging clinical scenario requiring multidisciplinary management. When endoscopic and interventional radiologic approaches fail to achieve durable hemostasis, surgical resection should not be delayed, particularly when definitive bleeding control is required for life-saving interventions such as organ transplantation. This patient's successful outcome underscores the importance of prompt surgical treatment of refractory GI bleeding in transplant candidates.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2104

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