[Rare massive upper gastrointestinal bleeding: Three cases of Dieulafoy's disease within diverticula of the descending duodenal and a literature review].

Dieulafoy's disease is a rare condition that can cause acute, life-threatening massive gastrointestinal bleeding and is prone to misdiagnosis and missed diagnosis. From May 2023 to April 2024, 3 patients with Dieulafoy's disease within diverticula of the descending duodenum complicated by upper gastrointestinal bleeding were admitted to the Affiliated Hospital of Zunyi Medical University and Dafang County People's Hospital. Their clinical data and diagnostic and therapeutic processes are reported to enhance awareness of this disease. All patients presented with massive gastrointestinal bleeding, manifested as recurrent hematemesis and hematochezia with large-volume bleeding, and were diagnosed by emergency gastroscopy as having Dieulafoy's disease within diverticula of the descending duodenum. After medical therapy, the outcomes were unsatisfactory in all 3 cases. Endoscopic examination revealed active bleeding located in the descending duodenum; using a side-viewing duodenoscope, the lesions were observed to be within the diverticula of the descending duodenum. Hemostasis was successfully achieved in all cases by endoscopic hemoclip placement. Dieulafoy's disease within diverticula of the descending duodenum complicated by gastrointestinal bleeding is relatively rare in clinical practice. For gastrointestinal bleeding of unclear etiology, endoscopic examination should maintain a high index of suspicion for the descending duodenum, and duodenoscopy should be used when necessary. Particular attention should be paid to rare bleeding causes occurring within diverticula to avoid missed or incorrect diagnoses that could delay treatment.