{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:14:06Z","timestamp":1788156846302,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Dieulafoy's lesion is an uncommon vascular anomaly that can cause life\u2010threatening gastrointestinal bleeding. While the stomach is the most frequently affected site, involvement of the major duodenal papilla is exceedingly rare and may escape detection with conventional forward\u2010viewing endoscopy. We report a rare case of papillary Dieulafoy's lesion presenting as obscure upper gastrointestinal bleeding in a patient receiving rivaroxaban. A 69\u2010year\u2010old woman with deep vein thrombosis receiving rivaroxaban, hypertension, and hypothyroidism presented with recurrent melena and severe anemia (hemoglobin 5.8\u20137.1\u2009g\/dL). Despite extensive evaluation, including capsule endoscopy, colonoscopy, and two forward\u2010viewing esophagogastroduodenoscopies, no bleeding source was identified. Persistent anemia and fresh blood in the second portion of the duodenum raised suspicion of a periampullary bleeding source. Side\u2010viewing duodenoscopy subsequently identified a 1\u2009\u00d7\u20091\u2009mm erythematous lesion with active bleeding at the major duodenal papilla, consistent with a Dieulafoy's lesion. Combination endoscopic therapy with epinephrine injection, bipolar thermal coagulation, and hemoclip placement achieved complete hemostasis. Rivaroxaban was temporarily discontinued, and no recurrent bleeding or post\u2010procedural pancreatitis occurred during 6\u2009months of follow\u2010up. This case highlights the diagnostic challenge of papillary Dieulafoy's lesions when conventional forward\u2010viewing endoscopy is non\u2010diagnostic. Early side\u2010viewing duodenoscopy is essential when a periampullary bleeding source is suspected, and combination endoscopic therapy can provide durable hemostasis, even in anticoagulated patients.<\/jats:p>","DOI":"10.1002\/ccr3.73203","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T13:50:45Z","timestamp":1785160245000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dieulafoy's Lesion of the Major Duodenal Papilla Presenting as Obscure Upper Gastrointestinal Bleeding: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8870-594X","authenticated-orcid":false,"given":"Aref","family":"Arminfar","sequence":"first","affiliation":[{"name":"Department of Medical Sciences Sha.C. Islamic Azad University  Shahrood Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0555-2466","authenticated-orcid":false,"given":"Soheil","family":"Shahramirad","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Sha.C. Islamic Azad University  Shahrood Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7847-7579","authenticated-orcid":false,"given":"Melika","family":"Nasehi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Sha.C. Islamic Azad University  Shahrood Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5828-7390","authenticated-orcid":false,"given":"Roya","family":"Jahanbazi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Yazd.C. Islamic Azad University  Yazd Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9992-7673","authenticated-orcid":false,"given":"Mohammad","family":"Danesh Pazhooh","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Sha.C. Islamic Azad University  Shahrood Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-470X","authenticated-orcid":false,"given":"Nasrin","family":"Razavianzadeh","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Sha.C. Islamic Azad University  Shahrood Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.4253\/wjge.v7.i4.295"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2023-001299"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/2324709620987703"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1108443"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.21037\/tgh.2020.02.17"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12328-020-01109-4"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2022.2043806"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.5946\/ce.2015.48.2.112"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-023-02913-1"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-223246"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.giec.2023.09.006"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1308\/003588410X12699663905311"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2015.02.005"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v19.i22.3505"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.4251\/wjgo.v13.i10.1466"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.11.010"},{"issue":"2","key":"e_1_2_12_18_1","first-page":"366","article-title":"Mechanical Versus Injection Endoscopic Therapy for Dieulafoy's Lesion: A Systematic Review and Meta\u2010Analysis","volume":"20","author":"Nahle T.","year":"2025","journal-title":"Maedica (Bucuresti)"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.024"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h1857"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13912"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-1173-8298"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73203","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73203","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73203","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:21:53Z","timestamp":1788153713000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73203"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":21,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ccr3.73203"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73203","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"assertion":[{"value":"2025-12-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73203"}}