Case Report Massive Gastric Hemorrhage due to Dieulafoy’s Lesion in a Preterm Neonate: A Case Report and Literature Review of the Lesion in Neonates Christos Salakos, 1,2 Panayiota Kafritsa, 3 Yvelise de Verney, 2 Ariadni Sageorgi, 4 and Nick Zavras 1 1 Department of Pediatric Surgery, ATTIKON University Hospital, 1 Rimini Street, Haidari, 12462 Athens, Greece 2 Department of Pediatric Surgery, “IASO” Maternity and Children’s Hospital, 37-39 Kifsias Street, Marousi, 15123 Athens, Greece 3 Department of Gastroenterology, “IASO” Maternity and Children’s Hospital, 37-39 Kifsias Street, Marousi, 15123 Athens, Greece 4 Neonatal Intensive Care Unit, “IASO” Maternity and Children’s Hospital, 37-39 Kifsias Street, Marousi, 15123 Athens, Greece Correspondence should be addressed to Nick Zavras; nzavras@med.uoa.gr Received 21 February 2015; Revised 14 May 2015; Accepted 24 May 2015 Academic Editor: Denis A. Cozzi Copyright © 2015 Christos Salakos et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dieulafoy’s lesion is an extremely rare cause of upper gastrointestinal bleeding in the neonatal age group. Till now, only 6 cases of Dieulafoy’s lesion in neonatal period have been reported in the international literature. Herein, we report an extremely rare case of Dieulafoy’s lesion in a preterm neonate. 1. Introduction Dieulafoy’s lesion (DL) is a distinct entity characterized by the presence of a large artery located under the muscularis mucosa and usually protruding into the gastric lumen [1]. Te lesion accounts for 0.3% to 6.7% of the upper gastrointestinal (GI) tract bleeding cases in adults [2]. However, its exact prevalence in the pediatric population is unknown as most published studies concern case reports. In a recent review of the English language literature, the authors identifed 28 pediatric cases with DL, among whom there were two full-term neonates and one preterm. All these neonates manifested the disease on the 1st, 3rd, and 4th postnatal day, respectively [3–5]. Herein, we describe a preterm neonate with DL. A brief review on neonatal cases is discussed. 2. Case Report A preterm male neonate was born as twin B afer an IVF preg- nancy to a 36-year-old gravida 1, para 2 mother at 26 +1 -week gestation, due to idiopathic preterm labor. His birth weight was 1010 g (90th percentile), and his length and head cir- cumference were 34 cm (50th percentile) and 25.4 cm (90th percentile), respectively. Apgar scores were 4 at 1 minute and 6 at 5 minutes. Te neonate was intubated to increase respi- ratory eforts and he was transferred to the neonatal intensive care unit (NICU). He remained on mechanical ventilation for 36 days. On day 65 of hospitalization (postconceptual age: 34 +5 weeks, weight 2020 g), he presented with a massive oral hematemesis and was transferred to the NICU yet again. On examination, he was pale and displayed mild abdominal dis- tention. Initial laboratory examinations showed hemoglobin of 10 g/dL (13.5–19.5 g/dL); hematocrit 29.3% (40–64%); WBC 5,050 cells/L (10.000–26000 cells/L); and platelet count 190,000/L (150,000–400,000/L). Te coagulation tests were normal. Afer a one-blood volume transfusion, esophagogastroduodenoscopy (EGD) was performed with an Olympus GIF-N180 neonatal endoscope, which identifed the presence of a big blood clot in the fundus, adherent to the gastroesophageal junction without signs of active bleeding (Figure 1). However, despite the eforts, the blood clot could not be reached even in full retrofexion. A second endoscopy was performed the following day afer a massive Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2015, Article ID 937839, 3 pages http://dx.doi.org/10.1155/2015/937839