Not to be Missed Entity: Dieulafoy's Lesion!

Clinically missed Dieulafoy's lesion is a significant cause of gastro-intestinal bleeding with a poor prognosis. We hereby compare an autopsy case of a similar nature; thereby highlighting the importance of autopsy. 69 years old male living in a retirement home was being managed for anemia. He was admitted with a preliminary diagnosis of septicemia with deteriorating renal function. He was found dead and referred for autopsy to our institute. At autopsy, 3 small defects at the gastroesophageal junction measuring about 5-7 mm were seen, which on microscopy revealed a relatively large artery at the submocosal level with rupture. There was about 2 liters of blood in the stomach. This was a Dieulafoy's lesion, the cause of sudden massive gastrointestinal bleeding and subsequent shock. This signifies that autopsy still holds its value in this modern era of diagnostics.