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.

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