MALToma Discovered on a Hemorrhagic Shock Associated with Gastric Dieulafoy's Lesion: A Case Report.

Introduction: Dieulafoy's lesion is a rare but severe cause of digestive bleeding and can rarely present as a hemorrhagic shock which is associated with a severe prognosis. MALToma is a B-cell lymphoma of the mucosa-associated lymphoid tissue. It was reported that MALToma can be revealed by a Dieulafoy's lesion. Due to the lack of specific endoscopic or clinical characteristics, several endoscopies may be needed to establish the diagnosis of MALToma. Case Presentation: A 61-year-old male patient presented to the emergency department with melena and hematemesis. The patient was transferred to the intensive care unit due to hemorrhagic shock. The endoscopic work-up showed large gastric folds which were later confirmed as MALToma in anatomo-pathologic analysis. The echoendoscopy showed a vessel going through the entire gastric wall which endoscopically corresponded to a red non-bleeding lesion, confirming Dieulafoy's lesion as the origin of the bleeding. The patient received an endoscopic treatment and was rapidly discharged from the intensive care unit. The evolution was spontaneously favorable, and there was no repeat active bleeding. Conclusion: A gastric MALToma was discovered thanks to a hemorrhagic shock on a Dieulafoy's lesion which has not yet been described in the literature.