Ampullary Dieulafoy: An Unusual Cause of Obscure Gastrointestinal Bleeding

A 65-year-old woman presented with multiple episodes of melena and a 5 g/mL decrease in hemoglobin level over a 6-month period. Three esophagogastroduodenoscopies and 2 colonoscopies were unremarkable. A capsule showed blood in the duodenum without an obvious source. Repeat upper endoscopy showed blood from the major papilla. Further studies were obtained including computed tomography, magnetic resonance imaging/magnetic resonance cholangiopancreatography, endoscopic ultrasound, bleeding scan, and an angiography —all were unremarkable.
Source: Clinical Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Image of the month Source Type: research