Dual Dieulafoy : an unusual presentation : case report

A 70-year-old man was admitted with massive haematochezia. It was the first episode, and had not been associated with haematemesis, melaena or abdominal pain. He was diabetic and hypertensive, but well controlled on insulin injections and enalapril. He was alert, but pale. The blood pressure was 90/60 mmHg, the pulse was 100/min, and there was fresh blood on rectal examination. The haemoglobin value was 4.7g/dl. Resuscitation was started, and blood transfusion initiated. Gastroscopy revealed a small mucosal defect in the pylorus, with clot on the base, suggestive of Dieulafoy lesion.