Laparoscopic Gastric Wedge Resection for Dieulafoy's Disease Following Preoperative Endoscopic Localization With India Ink and Endoscopic Clips

BACKGROUND: Dieulafoy's lesion is a vascular malformation, usually of the stomach but occasionally of the small or large bowel. It is an uncommon, but clinically significant, source of upper gastrointestinal hemorrhage. Three cases have been reported in the literature of laparoscopic gastric wedge resection of these lesions by using intraoperative endoscopic localization. We present the only reported case of preoperative endoscopic localization of a Dieulafoy's lesion with India ink and an endoscopic clip before laparoscopic resection. CASE REPORT: We present an 82-year-old female patient who presented to the emergency department with 3 episodes of hematemesis. Esophagogastroduodenoscopy revealed an actively bleeding Dieulafoy's lesion in the fundus of the stomach along the greater curvature, which was controlled endoscopically. However, the patient had a recurrent episode of bleeding. Repeat endoscopy was performed and the lesion was tagged with 2 endoscopic clips and marked with India ink. A laparoscopic wedge resection was performed after the India ink was identified in the fundus. The patient did well postoperatively. CONCLUSION: Preoperative localization of a Dieulafoy's lesion with India ink and endoscopic clips before laparoscopic wedge resection is a feasible procedure. Therefore, no need exists for intraoperative endoscopy to aid in the localization, as previously reported.